TB/HIV Monitoring and Advocacy

Communities 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. 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 Policy on Collaborative TB/HIV Activities (2004).

Background

From 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 Grant Competition.

The purpose of the grant competition was to support community-based organizations, led by people living with HIV/AIDS in their efforts to demand for effective and coordinated programs on TB/HIV and to mobilize resources for joint TB/HIV programming. The activities of these grantees 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) will launch a third grant competition, the TB/HIV Monitoring and Advocacy Project, to promote and support community-led monitoring and advocacy around adaptation and implementation of the TB/HIV Policy.

The joint effort between Public Health Watch and TAG highlights the importance of well-informed and targeted advocacy by the individuals and communities most affected by TB and HIV/AIDS in the design, implementation and evaluation of collaborative TB/HIV services and programs.

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 or non-governmental organizations (particularly those with substantive participation of people living with HIV/AIDS or TB) in assessing the need for expanded TB services in communities affected by HIV/AIDS and expanded HIV/AIDS services for TB patients;
• Support community-led advocacy around the needs identified in their assessments;
• Facilitate the participation of community activists in global networks of those most affected by the co-epidemic to articulate joint advocacy objectives and strategies at the regional and international policymaking level.

Through a competitive grantmaking process, community-based organizations will conduct field research to monitor implementation of TB/HIV collaborative activities using the WHO TB/HIV Policy. The policy outlines a set of recommendations for joint TB/HIV activities and calls upon countries to establish and implement necessary mechanisms to decrease the burden of TB among people with HIV/AIDS, and the burden of HIV among TB patients.

The TB/HIV Monitoring and Advocacy Project will provide grant awards of $5,000 to $10,000 to conduct in-country TB/HIV monitoring and advocacy at the national or subnational level. The amount of the grant awards will be determined by the level of monitoring and advocacy performed, as well as by organizational capacity.

Project grantees will work from a common methodology, which includes a topic-specific questionnaire to conduct a qualitative assessment of TB/HIV collaborative activities. Research activities include but are not limited to: site visits to local HIV/AIDS and TB clinics, desktop research and interviews with 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 or lack thereof, and provide recommendations to improve TB/HIV services and care, as well as potential strategies to improve the monitoring framework itself.

The TB/HIV Policy identifies community-led monitoring and advocacy as a necessary means to accelerate and improve TB/HIV services, the project will support community-based grant recipients to present their findings at national and international health forums, such as the International Union Against Tuberculosis and Lung Disease (IUATLD) and the International AIDS Society conferences. These forums will provide advocacy opportunities for grant recipients to influence decision-makers to increase political commitment and resources for collaborative TB/HIV programs.

TB/HIV Community Advisory Committee

Public Health Watch and TAG established the Community Advisory Committee (CAC) in February 2006 to support the TB/HIV Monitoring & Advocacy Project. The CAC is a group of global TB/HIV advocates that provide regional and local TB/HIV expertise on grant selection, implementation, training, evaluation, and project-related advocacy. The CAC is composed of the following TB and HIV/AIDS advocates, each of whom possess significant experience in community-led advocacy in some of the countries and communities most affected by the dual TB/HIV epidemic.

Fogué D. Alain, President, Positive Generation

Konjengbam Birjit Singh, President, Social Awareness Service Organization

Lucy Chesire, Kenya Treatment Advocacy Movement, Clinical Nutritionist

Tamara Gvaramadze, Deputy Director, Georgian Plus Group

Nenita L. Ortega, Board of Adviser, Pinoy Plus Association

Ezio T. Santos, MSc; Consultant on TB/HIV Social Mobilization, Grupo Pela VIDDA

Pervaiz Tufail, Program Manager, Amal Human Development Network

Jacob Zannou, President, Horizon Environment Sante