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

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.