Best Practices in the Integration of TB and HIV/AIDS Services
In most countries, tuberculosis (TB) services are decentralized up to the most peripheral health facilities and often into the community. On the other hand, HIV/AIDS services are generally much more centralized because scale-up of services, especially of antiretroviral therapy (ART), started only quite recently. As a result, patients who need treatment for both TB and HIV/AIDS may be required to attend two separate clinics and travel long distances to access the services. Lack of integrated TB/HIV services can create delays in diagnosis and treatment, and result in poor compliance and treatment interruption. Patients also face a financial burden related to the cost of travel and other indirect costs, such as long waiting times and potential loss of income.
Although many countries have adopted the interim World Health Organization (WHO) policy on collaborative TB/HIV activities, the level of implementation and integration of TB and HIV/AIDS services at the service delivery points varies from country to country and also from one setting to another within the same country. There is limited information that documents countries’ experiences integrating TB and HIV/AIDS services and the lessons learned from those experiences.
The review was conducted by the Tuberculosis Control Assistance Program (TB CAP) in five countries (Benin, Cambodia, Kenya, Malawi, and Rwanda) and focused on capturing the strategies, approaches, and steps that were used to integrate TB and HIV/AIDS services at the point of service delivery. The review also documented the experiences, best practices, and lessons learned in each of the five countries. All this information is gathered in this manual to assist other countries and settings as they endeavor to integrate TB and HIV/AIDS services.
This manual describes the opportunities and challenges of each model and highlights best practices and lesson learned from the five countries.