HERD - NEPAL

Linking TB and HIV/AIDS services in Asia

Many countries in Asia have both high rates of TB and an increasing incidence of HIV. TB is likely to be the foremost cause of death of those infected with HIV. Unlike in Africa, in most Asian countries the two diseases are not closely linked yet in that the majority of TB cases are HIV negative. However, rates of HIV/AIDS are likely to increase dramatically in Asia, and links between TB and HIV/AIDS services will be essential. Despite many calls for the development of links between TB and HIV services in Asia, progress has been slow. The national policy in this area has not led to changes in practice.

The goal of this study is to use an inclusive approach to develop and assess guidelines for TB-HIV collaboration in a small number of districts of Nepal. This pilot project aims to determine a working model of TB-HIV collaboration at district and service delivery levels, develop evidence-based national operational guidelines for TB-HIV collaboration. Problems and issues arising during implementation will be documented in order to enhance adoption of TB-HIV collaboration in other Asian countries. The study will be conducted using a working group approach comprising all stakeholders throughout the process including development of guidelines; operational research and model to address problems that arise; and the partners' experience in developing and rolling out strategies. Standard guidelines and tools for capacity building, programme monitoring and evaluation, systems of referral within the two programmes and health information management will be developed and tested. The study outcome targets will be assessed using indicators for evaluating the process of implementation and health service outputs.

The directors of the TB and AIDS control programmes, NGOs involved in HIV-AIDS care and support, and associations of PLHA will be closely involved in the study. SAARC and COMDIS links will disseminate findings to other Asian countries.