Grants & Focus AreasCommunities affected by TB and HIV should play a central role in planning, delivering and monitoring collaborative TB/HIV activities. Community involvement in planning and monitoring services will ensure that the service responds to the communities needs.
—Stop TB Strategic Plan 2006–2015
TB and HIV constitute a deadly co-epidemic in many regions of the world: HIV/AIDS is the greatest risk factor for the development of active TB and is fueling a resurgence of the TB epidemic in areas of high HIV prevalence. At the same time, TB is a leading cause of illness and death among people living with HIV/AIDS. Current estimates indicate that twelve million people are coinfected with TB/HIV. According to the World Health Organization (WHO), TB accounts for approximately 15 percent of AIDS deaths worldwide and nearly 30 percent of AIDS deaths in sub-Saharan Africa.
Despite the clear linkage between these two diseases, there has not been sufficient collaboration between national TB and HIV/AIDS programs and policies in many countries.
The WHO has sought to promote greater collaboration between national TB and HIV/AIDS programs, with the strategic goal of “reduc[ing] TB transmission, morbidity and mortality, as part of overall efforts to reduce HIV-related morbidity and mortality in high HIV prevalence populations.” To provide support and guidance to governments for the development of integrated TB and HIV/AIDS policies, the WHO published the Interim Policy on Collaborative TB/HIV Activities (2004).
Background
In 2004–2005, the Open Society Institute awarded 31 grants to community organizations in 21 countries to implement a wide range of advocacy activities to promote more integrated TB and HIV/AIDS policies and programs through its TB/HIV Advocacy Grants Project.
Grants supported community-based organizations led by people living with HIV/AIDS in advocating for more effective and coordinated programs to address TB/HIV. During the course of their advocacy activities, grantees articulated the need to mobilize resources for joint TB/HIV programming, increase civil society participation in the design, delivery and evaluation of TB/HIV services, and win greater political commitment to expand TB/HIV collaborative activities. Perhaps most importantly, grantees’ experiences affirmed that more community-level involvement—and more structured support for community-level involvement—is necessary to accelerate the development and implementation of TB/HIV services and care.
Drawing on the achievements of the first two rounds of the grant competition, OSI’s Public Health Watch and the Treatment Action Group (TAG) launched the TB/HIV Monitoring and Advocacy Project to promote and support community-led monitoring and advocacy for adoption and implementation of the WHO-recommended TB/HIV Policy.
TB/HIV Monitoring and Advocacy Project 2006
Consistent with the mission of Public Health Watch, the TB/HIV Monitoring and Advocacy Project seeks to increase civil society engagement in policymaking efforts towards the adoption and implementation of collaborative TB/HIV activities.
To this end, the project will support:
- community-based organizations to monitor the availability, accessibility and quality of TB/HIV services in their communities;
- community-led advocacy to follow up on needs and recommendations identified during the monitoring exercise;
- participation of community-based activists at regional and global policymaking forums to pursue joint advocacy objectives and strategies.
In May 2006, the TB/HIV Monitoring & Advocacy Project issued a call for proposals from community-based organizations to monitor implementation of the WHO TB/HIV Policy. The Policy outlines a set of recommendations for collaborative TB/HIV activities to decrease the burden of TB among people with HIV/AIDS, and the burden of HIV among TB patients.
Public Health Watch and TAG screened over 180 proposals and recommended 36 for review by the Community Advisory Committee (CAC). Decisions were finalized in June and in early July, the project awarded 12 community-based organizations with grants of $5,000 to engage in community-led monitoring of the TB/HIV Policy. To learn more about the TB/HIV grantees, please click here.
For the monitoring phase of the project, grantees use a topic-specific interview tool to prepare a qualitative assessment of TB/HIV activities at the national or subnational level. The interview tool was developed and structured around the main points of the WHO TB/HIV policy [link to WHO policy] and therefore provides a common framework for grantees to evaluate the availability, accessibility and quality of collaborative TB/HIV activities and make recommendations for improvement. Grantees will conduct monitoring over the course of six months and will undertake site visits to local HIV/AIDS and TB clinics, desktop research and key informant interviews with people in affected communities, health care workers, and government officials. The research conducted in the field will form the basis of a report that will describe the current state of joint TB/HIV activities, identify policy strengths and weaknesses and offer recommendations for improving the quality and accessibility of TB/HIV services.
Upon completion of the monitoring phase in the spring of 2007, grantees will be eligible to receive additional funding support for follow-up advocacy. The advocacy phase of the project is designed to provide grantees with the opportunity to act upon some of the most significant findings highlighted in their research. Grantees will be asked to develop a six month advocacy strategy and budget to support activities such as: report launch events, media outreach (press releases, briefings, journalist workshops), presentations at local or national conferences (HIV/AIDS, health, TB), roundtable meetings with policymakers, workshop trainings, outreach activities to donor agencies for resource mobilization, production of fact sheets for policymakers or treatment literacy material for health care workers and/or affected communities among other activities. In developing and leading these advocacy events, grantees will be aiming to convince or persuade policymakers and health officials to accelerate or improve upon implementation of collaborative TB/HIV policies and services.
The TB/HIV Policy identifies community-led monitoring and advocacy as a necessary means to accelerate and expand TB/HIV services. In addition to local level advocacy, the project will support grantees to present their findings at international health forums, such as the International Union Against Tuberculosis and Lung Disease (IUATLD) and the International AIDS Society conferences. By securing international advocacy opportunities, the project aims to leverage local level efforts to persuade decision-makers at the global level to increase political commitment and targeted resources to support well-designed collaborative TB/HIV programs.
TB/HIV Community Advisory Committee
To support project implementation, Public Health Watch and TAG established a new TB/HIV Community Advisory Committee (CAC). The 2007-2008 CAC comprises six TB and HIV/AIDS advocates, all of whom possess significant experience in community-led advocacy in some of the countries and communities most affected by the dual TB/HIV epidemic. The CAC provides expert advice and support as well as a strong community perspective on monitoring tools, grantee selection, grant implementation, training, evaluation, and project-related advocacy.
Fogué D. Alain Patric Ledoux, President, Positive Generation
Konjengbam Birjit Singh, Consultant, Social Awareness Service Organization
Lucy Chesire, Clinical Nutritionist, Kenya AIDS NGO Consortium
Tamara Gvaramadze, Deputy Director, Georgian Plus Group
Ezio T. Santos, Independent Consultant on TB/HIV Social Mobilization
Pervaiz Tufail, Director, Organization for TB People Pakistan
