1. Lessons learned about TB/HIV collaboration

2. National
Community
Health System
Individual and
his/her immediate
network

3. TB and HIV - converging philosophies
TB Control
DOTS
Need for care
HIV Control
IEC
Condoms
Multisectoral
STIs
Community
contribution
Medical approaches
Hospital
Clinic
Decentralisation
Private practitioners

4. Epidemiology
Anthropology
Reduction in mortality, morbidity and stigma due to tuberculosis and HIV
Clinical
Policy

5. Government and NGO services District management National departments
Collaboration and discussion has been stimulated at many levels, with positive results
Clinic services
Government and NGO services
District management
National departments
International agencies

6. Health systems cause stigma
Nurses in Limpopo province find holistic VCT training helps in the clinic and in the community
Major opportunities arise in the way in which the system is structured
Specialised HIV clinics surprisingly acceptable
Pronyk, Makhubele et al IJTLD 5:

7. Kanayaka - “the light is on” or “the sun is shining through”
Distinguish and label differences
Associate human differences with negative attributes
Status loss and discrimination
HIV/TB
Separation of “us” from “them”
B.Link and J.Phelan NIH 2001; Ginny Bond Sida studies :29-53

8. Health care staff feel encouraged
Morale
Reduces stigma
Capacity building
Impact on family and community too

9. Government and NGO relationships
Mutually beneficial
Needs good two way communication

10. District management Need to be engaged from the start
Expansion occurred within the project or planned for the next years

11. National departments Catalysed discussions
Contributed to development of TB/HIV expansion plans in all three countries

12. International agencies
Catalysed discussions
Contributed to strategic framework development

13. Recommendations

14. National level
Promote opportunities for districts to develop coherent TB/HIV care and prevention activities.
Use experience from early adopting districts to develop expansion plan
Use experience from early districts to assist in training

15. District level
Conduct situation analysis to define opportunities to share the workload associated with TB/HIV
District health management team should be the lead agency
Hold regular meetings with representation from all major providers

16. Clinic/facility level
Train and support sufficient nurses or lay workers to provide a package of care
Ensure training confronts stigma and personal fears

17. General
Encourage social scientists to collaborate in understanding the social context of TB/HIV

18. What do we still need to know?

19. We already know enough to recommend that TB and HIV teams should seek opportunities to collaborate at international, national, district and facility level.
We need further operations research to study the process and impact of expansion from pilot sites to scaled up district TB/HIV collaboration