Facilitating interaction between TB and AIDS medical services for better management of patients with co-infections

Abstract

The Newly Independent States inherited two vertical services for tuberculosis (TB) and AIDS control from the Soviet Union. TB is an important cause of morbidity in the Central Asia Region (CAR). In recent years, HIV epidemics started growing rapidly, especially among injection drug users. TB is the most common AIDS-related opportunistic infection, leading to early deaths among AIDS patients and increased transmission of TB in the general population. An assessment carried out between March 2005 and May 2005 revealed that TB and AIDS services in CAR rarely interacted for the management of patients with co-infections. Following the assessment, the USAID-funded CAPACITY Project promoted cooperation between TB and AIDS services in Uzbekistan, Tajikistan, and Kyrgyzstan. For the first time, representatives from the Ministries of Health and Justice, national and regional TB and AIDS centres, international organizations, and local non-governmental organizations (NGO) gathered to discuss mechanisms for linking TB and AIDS services to address the growing needs of co-infected patients. Technical Working Groups (TWG) established through this cooperation developed linkages between TB and AIDS services. These groups developed protocols, guidelines, and training programmes. Hundreds of medical specialists, health managers, and monitoring and evaluation specialists were trained and national teams of trainers were built. TB/HIV model sites were designed in each country and the models were implemented to test and refine the approaches for patients with co-infections. Key to the success of the approach has been the emphasis on wide participation from all stakeholders. Upon completion, successful models will be advocated for funding and national scale-up.

Keywords:

• Tuberculosis (TB)
• HIV
• AIDS
• collaboration
• participation
• Central Asia
• Uzbekistan
• Tajikistan
• Kyrgyzstan

The CAPACITY Project is implemented by JSI Research & Training Institute, Inc., with partners Abt Associates, Boston University, Howard University, the International HIV/AIDS Alliance, and Population Services International. We would like to express our sincere appreciation for the hard work and dedication of the Ministries of Health, the national and provincial AIDS and TB centres in Uzbekistan, Tajikistan, and Kyrgyzstan, and the National AIDS Unit of Kyrgyzstan. We would also like to express our gratitude to the United States Agency for International Development (USAID) for its generous financial support of our project (cooperative agreement #176-A-00-04-00014-00). The opinions expressed and conclusions drawn in this paper are those of the authors, and may not be those of USAID or of the governments of Uzbekistan, Tajikistan, and Kyrgyzstan.

Notes

1. Project operations in Turkmenistan, which is also part of the CAPACITY project, had not begun as of the time of writing this paper. Negotiations with the Government of Turkmenistan were ongoing at the time.

2. All tools, protocols, and reports are available from the CAPACITY project. Anyone interested should send an email request to [email protected]

3. Uzbekistan, Tajikistan, and Kyrgyzstan were selected (in that order) due to readiness of the Ministries of Health in each country to work with the CAPACITY Project on this issue. The Kazakhstan Ministry of Health (MoH) had already developed protocols for linking AIDS and TB services, though implementation had not started. CAPACITY is participating in another process (not the subject of this paper) on this issue with a number of other organizations in Kazakhstan led by the MoH.