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This document is prepared to provide information about good practices on Tuberculosis control in SAARC Member States. Good practices comprise examples of programmes, projects and activities that have been shown to contribute towards making interventions successful. Sharing good practices is important.
Globally, people who use drugs (PWUD) remain stigmatized and criminalized, which contributes to devastating health disparities, including extremely high rates of TB often combined with HIV and viral hepatitis. The range of these health issues and the prevailing lack of integrated health services capable of delivering TB, HIV, and harm reduction services in one place largely contribute to the scope of the TB crisis in communities of PWUD.
Health care workers (HCWs) are at an increased risk of acquiring tuberculosis (TB) compared to the general population. In low-resource, high-TB-burden settings, occupationally acquired TB is depleting the very workforce fighting the disease on the frontline. Failures in health systems, occupational health (OH) services and TB infection control (TBIC), staffing shortages, supply issues, lack of funding, and lack of supervision, are putting the lives of HCWs, their families, and those they are tasked with caring for at risk. The fear of stigma, coupled with weak labour protections and poor confidentiality measures, often means that HCWs are afraid to disclose their health status to employers for fear of being ostracized or losing their jobs.
Keywords: HIV, health services, treatment, stigma, policy
Over the past several decades, the weakening of criminal justice systems and reliance on ineffective, overly punitive policies have led to the deterioration of prisons globally. This has caused overcrowding and facilitated the spread of infectious diseases such as TB and multidrug-resistant TB (MDR-TB). Prisons are intrinsically linked to communities; thus, the TB and MDR-TB epidemics in prisons have impacted health outcomes in countries where excessive incarceration is prevalent.
While HIV-induced immunosuppression makes people living with HIV (PLHIV) extremely vulnerable to TB, stigma, absence of precise point-of-care diagnostics, and poor integration of TB and HIV services make TB particularly deadly for this population. Along with stigma, other factors such as gender, poverty and malnutrition promote delays in diagnosis, present barriers to treatment, and impact patients’ adherence to medications.
Global statistics indicate that the TB burden is more acute in urban areas. However, in countries where large portions of the population are rurally located and reside in extreme poverty, TB is dominant among rural dwellers. Poverty and limited access to health facilities and health workers significantly diminish the ability of people with TB who reside in rural areas to obtain timely diagnosis and treatment.
Globally, the prevalence of TB is much higher in urban areas than in rural areas. Around 54% of the world’s population now lives in cities, with the most rapid rates of urbanization being witnessed in developing countries. In the developed world, urbanization has led to overall improvements in health, but this trend has not been mirrored in less-developed regions of the world. In these settings, the key social and economic determinants of TB converge on the poorest populations.
This guide to Supervision, Monitoring and Evaluation (SM&E ) has been developed to assist the program managers and staff of RNTCP and NACP programmes at various levels to effectively implement collaborative TB-HIV activities. It is intended to facilitate the quality implementation of TB HIV collaborative activities, collection of standardized data, and help in the interpretation and dissemination of these data for programme improvement. It also aims to ensure uniformity across all stakeholders involved in TB-HIV collaborative activities and harmonisation of data collection at various levels by developing a core set of globally accepted, standardized indicators for monitoring and evaluating programme performance. The data collected using these standardized indicators will provide further evidence for policies related to collaborative TB/HIV activities.
WHO recommends implementation of collaborative TB/HIV activities to reduce burden of HIV associated TB. There has been considerable scale-up in implementation of these activities globally over past one decade. However the levels of implementation differ depending on type of HIV epidemic, high, low or concentrated. Although the scale-up of TB/HIV interventions in high burden countries has been substantial, countries with low and concentrated HIV epidemic struggled to achieve national coverage. The key challenges being gaps in infrastructure and resources for tuberculosis and HIV care. India has a concentrated HIV epidemic but carries third highest burden of HIV associated TB in the world. This case study provides practical tips and insights to facilitate national scale-up of collaborative TB/HIV activities
Keywords: HIV, prevention, control, TB service, ART, testing
The World Health Assembly, convened annually by WHO at the UN Palais des Nations in Geneva, passed a resolution in May 2014 approving with full support the new post-2015 Global TB Strategy with its ambitious targets. The strategy aims to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, and to ensure that no family is burdened with catastrophic expenses due to TB. It sets interim milestones for 2020, 2025, and 2030.