Community TB and HIV Care Group summary

1
Community TB and HIV Care Group summary

• Process
• Presentations on options for community
  involvement in TB
• Care
• Uganda experience with Community TB Care
• Comparing Community involvement in TB Care in
  Nicaragua and Burkina Faso (pilots).
• Global review (Mexico, Uganda and Bangladesh)
• Selected South African experiencestraditional
  healers programme, work place, etc
• Mark Harringtonviews from community groups

2
Emerging issues

• One size fits all does not work..context and
  process as important as intervention design
• Variations in concept and interpretation of
  community care and mobilisation affecting common
  understanding. Both are important and should be
  addressed in scaling up community based services.
• Important that patients and communities are part
  and parcel of all levels of services
  deliveryplanning, implementation, evaluationnot
  just subjects in the intervention
• TB community tend to be conventional and not
  involved sufficiently in social and community
  mobilisation to place TB high on political agenda
  in the same way HIV/AIDS has done. There is great
  potential for the two communities to learn from
  each other
• Need to also scale up basic research to support
  for TB interventions
• Treatment literacy is an important element of
  service seeking and treatment adherence
• The evidence for DOT in the TB Strategy still not
  conclusive

3
Recommendations / conclusions

• Clarify, reach consensus and harmonise
  terminology between constituencies with regard to
  community based care / involvement including in
  key strategic documents such as the new Stop TB
  Strategy to reflect a broader meaning and not
  just a care meaning
• Recommendation of DOT in the TB Control Strategy
  should be revisited to reflect patient support
  rather than directly supervised treatment.
  Evidence for need for DOT should be enhanced
  including randomised clinical trials if
  necessary.
• Adoption of approaches to recommend should be
  based on satisfactory treatment outcomes with
  enough flexibility to facilitate feasibility
  (while maintaining quality)
• Prevalence surveys are important to determine
  baselines and could be included in GFATM grant
  applications
• There should be reorientation of traditional
  health systems and workers to create conducive
  environment for community participation in
  services delivery