TB/HIV: a clinical manual - libdoc.who.int - World Health Organization

For these patients, the treatment supporter who directly observestreatment could be one of the health staff in the health facility. Some TBpatients live far away from a health facility. For these patients, thesupervisor may be a trained local community member or a healthoutreach worker. Family members who provide health care support canalso be trained as TB treatment supporters. Some areas have HIV/AIDScommunity care schemes. With suitable training and supervision, theHIV/AIDS home care providers can support TB patients, includingdirectly observing treatment.Integration of TB treatment services with general health servicesIn the past, some TB programmes have relied on special TB hospitals andclinics, separate from the general health service.The problem with thatsystem is that many TB patients live far from a TB hospital or clinic. Onereason why TB is out of control in many countries is that TB patients donot have access to TB diagnosis and treatment services. A successfulNTP brings TB diagnosis and treatment services to the TB patients.Thisis why TB treatment services are integrated with existing general healthservices.2.4 TB/HIVTB and HIV are closely interlinked.TB is a leading cause of HIV-relatedmorbidity and mortality. HIV is the most important factor fuelling the TBepidemic in populations with a high HIV prevalence. The WHO globalstrategic framework to control TB/HIV represents a coordinatedresponse to the joint epidemics of TB and HIV. Collaboration betweenTB and HIV/AIDS programmes is crucial in supporting general healthservice providers. These providers need support in delivering the fullrange of HIV and TB prevention and care interventions. To counteractthe impact of HIV on TB, other interventions are required apart fromeffective TB case-finding and cure.These interventions includeº measures to decrease HIV transmission (e.g. promotion of condoms,treatment of sexually transmitted infections, voluntary counselling andHIV testing, safe intravenous drug use, reduction in the number ofsexual partners, prevention of mother-to-child HIV transmission, HIVscreening of blood for transfusion, and application of universal HIVprecautions by health care workers);º antiretroviral therapy (ART) (to improve or maintain immune functionin people living with HIV infection);º care for people living with HIV infection (e.g. treatment of HIV-relateddiseases, prevention of HIV-related infections,TB prevention, palliativecare and nutritional support).46AN EXPANDED FRAMEWORK FOR EFFECTIVE TB CONTROL