Table 5 Examples of programme activities where joint efforts for HIV and for tuberculosis epidemic control can be better integrated into a strengthened health system
Programme activity | Challenge | Example of HIV and tuberculosis programme collaboration | Consequence for strengthened health system |
|---|---|---|---|
Programme monitoring and evaluation | Difficulty in measurement of the success of HIV treatment programmes because of highly heterogeneous monitoring systems and use of non-standardised definitions across programmes [46] | Joint contribution to development of standard measures for monitoring success of treatment, e.g. ART for HIV infection, learning from experience of standard outcomes in global tuberculosis control [44] | Better global documentation of overall rate of successful outcome of treatment of HIV/AIDS a priority disease of poverty |
Programme monitoring and evaluation | Lack of a vital registration system in many of the countries most badly affected by HIV or tuberculosis (only five countries in Africa have vital registration systems covering more than 25% of the population) [57] | Joint support of efforts to develop national vital registration systems | Improvements in coverage and quality of vital registration systems would be of considerable benefit for better data on deaths of people with priority diseases of poverty, e.g. HIV and tuberculosis |
Infection control in health and other congregate facilities | Lack of quantitative measure of implementation of measures for HIV infection control and slow progress in implementing TB infection control interventions [46] | Joint contribution to development and implementation of effective health system policies for infection control in health and other congregate facilities | Strengthened ability of health system to protect patients from nosocomial infection |
Raising community awareness of health-seeking behavior | Late presentation during disease progression of patients with HIV [11] and patients with tuberculosis [12] | Joint development and implementation of comprehensive communication measures aimed at raising community awareness of the importance of seeking health care earlier in the course of progression of priority diseases, e.g. HIV and tuberculosis | Better outcomes of treatment of patients presenting earlier in the course of disease, with health system efficiency savings |
Risk behavior modification | High continued levels of behaviour involving personal risk, e.g. unsafe sex [4] as a risk for HIV infection, and lack of cough hygiene as a risk for transmission of tuberculosis [27] | Joint contribution to comprehensive health education aimed at promoting healthy behavior and decreasing risk of HIV and tuberculosis | Improved health system approach to behavior modification regarding risk of HIV and tuberculosis among a wide range of diseases |
Treatment scale-up (first-line treatment regimens) | Inadequate access to effective treatment of HIV infection [46] and tuberculosis [13] | Joint contribution to development and implementation of health system policies for decentralized provision of treatment of priority diseases, e.g. ART for HIV/AIDS, based on experiences of decentralised treatment of tuberculosis [52] | Faster progress towards goal of universal access to key interventions for control of priority diseases of poverty |
Drug-resistance surveillance | Despite recent progress, insufficient laboratory capacity in countries most badly affected by HIV and by tuberculosis for surveillance of resistance to antiretroviral [46] and antituberculosis [13] drugs | Joint support of development of national and international capacity for drug-resistance surveillance, including resistance to antiretroviral and antituberculosis drugs | Improved health system capacity for drug-resistance surveillance, including resistance to antiretroviral and antituberculosis drugs |
Containing and countering drug-resistance (including rational use of second-line treatment regimens) | Supporting health system capacity to contain drug-resistance, by learning mutual lessons from experiences in HIV and tuberculosis treatment | Improved health system capacity to contain resistance to drugs used in treatment of a wide range of diseases | |
Research and development for new diagnostics, drugs and vaccines | Inadequate development of new diagnostics, drugs and vaccines, especially for tuberculosis [51] | Joint support of advocacy for increased funding, and for development of platforms, for research and development | More efficient and effective health system contribution to development of new technologies for disease control |
Global advocacy for resources | Competition between advocates promoting resource mobilisation for different diseases | Joint advocacy for funding of strong health systems which are able to respond effectively across a range of disease priorities and benefit from synergies of approaches to different diseases | More effective health system based on funding of disease control commensurate with the burden of disease |
Global partnership | Failure to maximize synergies and avoid duplication and dispersion of effort among partners | Joint support of global partnerships which embrace joint HIV and tuberculosis issues (e.g. Global Fund for AIDS, Tuberculosis and Malaria) and of more cohesive global HIV partnerships, learning from lessons of the global Stop TB Partnership [58] | More effective and efficient roles played by partners in global health partnerships and in global HIV and tuberculosis partnerships |