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Community involvement in scaling up TB/HIV activities. Achievements. Cambodia “TB volunteers” – community-based NGO volunteers involved in decentralized DOT for 50% of country; now also involved in TB/HIV Link TB clients to HIV testing Screen PLHIV for TB

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achievements
Achievements
  • Cambodia “TB volunteers” – community-based NGO volunteers involved in decentralized DOT for 50% of country; now also involved in TB/HIV
    • Link TB clients to HIV testing
    • Screen PLHIV for TB
    • Impact: Improved HIV testing of TB patients
  • India & Bangladesh – PLHIV networks involved in ICF and communication
    • Educate PLHA on TB
    • Perform ICF in a variety of settings
    • Support referrals
achievements continue
Achievements continue
  • Vietnam – NGO home-based care for HIV includes family education/sensitization on TB and linkage to TB services.
  • India – involvement of Targeted Intervention NGOs in TBHIV services for High-Risk Groups (CSW, IDU, MSM)
    • Services: ICF, referral of TB suspects, DOTS
  • Other successful examples cited
    • Zambia: Community members staff “TB desks” in HIV clinics, and “HIV desks” in TB clinics
    • South Africa: TAC involved in advocacy, e.g. TB diagnostics
constraints challenges
Constraints & challenges
  • Culture clash – historical medical approach to TB control lacked major role for community
    • Not used to partnerships with civil society, client community
    • Underlying lack of patient empowerment
  • Resources few (No demand/ no supply)
  • Donor driven – and they are not steering in this direction
    • Evaluation frameworks favor medical interventions over HR and meeting-intensive community involvement
    • Missing clear standardized M&E framework for monitoring ACSM activities & quantifying impact for performance-based funding mechanisms
  • Community with limited access to high-level discussions
constraints challenges5
Constraints & challenges
  • Literacy around TB limited
    • TB as preventable, rather than inevitable
    • TB IC as patients / health care worker safety
    • Effect of stigma
  • Limited capacity
    • National: technical support for planning, developing partnerships and proposals
    • Sub-national: limited capacity for multi-lateral initiatives & partnerships with local organizations
    • Community: NGO/CBO/PLHIV network has limited capacity to expand activities and campaigns; very limited networks of TB survivors
  • Community networks (local lay health workers – e.g. ASHA, village health worker) often not utilized for either disease
opportunities
Opportunities
  • Leverage extensive HIV community involvement for TB
  • Grow community involvement for TB and use this to also support TB/HIV activities
way forward
Way forward
  • NTP, NAP and partners
    • Promote clients empowerment (NTP)(eg Clients charter)
    • Sensitize of lay workers, PLHIV groups, HRG groups, labor/workplace community groups.
    • Promote treatment/TB-HIV literacy among community
    • Include TB in NGO/CBO activities for most-affected populations
    • Document and disseminate successes
    • Engage untapped networks of lay health workers for both diseases
way forward8
Way forward
  • Technical partners
    • Support capacity NTP/NAP – programs to engage civil society (sub-national)
    • Develop national consultants to support planning and partnerships
    • Advocating with donors to support community involvement
    • Develop M&E framework for community involvement that donors agree on
    • Develop evidence on risk of TB, infection control to community
  • PLHIV groups
    • Promote treatment/TB-HIV literacy
    • Include TB in all advocacy agenda.