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ProTEST Workshop on HIV-Related TB

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A four-day workshop was held in Durban, South Africa to document the experiences from the ProTEST pilot projects in Malawi, South Africa, and Zambia. These projects sought to establish a district-based strategy for a collaborative approach to HIV-related tuberculosis (TB) using operational research. The workshop was coordinated by the World Health Organization (WHO) in collaboration with the South African Medical Research Council (SAMRC) and the National Department of Health (SANDoH). The main objectivesof the meeting were to present quantitative and qualitative data from the pilot projects, identify the lessons learned, and translate this knowledge into policy recommendations for future expansion of collaborative TB and HIV programme activities.

The pilot projects (which were funded by Norwegian Agency for Development Cooperation (NORAD), Department for International Development (DFID), SANDoH, the United States Agency for International Development (USAID), UNAIDS, and the Centers for Disease Control (CDC)) were intended to develop and evaluate the feasibility, impact, and cost-effectiveness of interventions to decrease the burden of HIV-related TB. Plans to expand the ProTEST project to Ethiopia, Mozambique, Tanzania, and Uganda are underway, and will be shaped by this conference.
Communication Strategies

Seventy participants, including national TB and HIV/AIDS programme managers, development and technical agency representatives, and ProTEST coordinators, attended the meeting.

The principle investigators from each of the pilot projects presented their results on the first day. On the second day working groups identified the lessons learned from the pilot project and discussed results and experiences. On the third day the issue of tools, targets, and indicators for monitoring and evaluation of TB/HIV collaborative activities was addressed in plenary and working groups. On the last day conclusions were drawn and policy recommendations were made for future TB/HIV collaborative activities.

PowerPoint versions of these presentations may be accessed on the ProTEST Lessons Learned Workshop page on WHO's TB site. Question-and-answer sessions and working groups were also conducted. A final report from the workshop will be available on the same website shortly.

Development Issues

HIV/AIDS, TB.

Key Points

The ProTEST approach entails the promotion of HIV counselling and testing as an entry point into a package of interventions aimed at reducing the dual burden of HIV/TB. The meeting concluded that collaboration between TB and HIV/AIDS programmes is feasible and helps to improve general health services delivery throughcapacity development, staff motivation, better referral networks, and more efficient use of resources and may help to reduce stigma and improve staff morale. Data suggested that the interventions offered in ProTEST - intensified case-finding for TB, isoniazid TB preventive therapy (IPT), and cotrimoxazole preventive therapy (CPT) - could be offered within a package of care for HIV-infected individuals. However, it was noted that further work is needed to demonstrate the impact these strategies might have on the TB/HIV burden (a behavioural study is underway). Organisers anticipate that the low cost of adding these interventions to existing services will make the services cost-effective; they are awaiting results of an economic analysis. Standardised tools for monitoring and evaluating future TB/HIV collaborative activities were seen as a priority and are being developed.


Participants concluded that HIV/AIDS and TB control programmes can work together effectively, at all levels, to provide a continuum of prevention and care services for people living with HIV/AIDS and/or TB.

Partners

WHO Headquarters (Geneva) and the WHO Regional Office for Africa, SAMRC, and SANDoH. Funding was provided by the National Department of Health, CDC-GAP, USAID, and WHO.

Sources

Article in the February 2003 Edition of Stop TB Partnership Communique; and Report of a "Lessons Learnt" Workshop on the Six ProTEST Pilot Projects in Malawi, South Africa and Zambia, Durban, South Africa, February 3-6 2003, published by WHO in 2004.