Consolidated Guidelines

2.5.1 In conjunction with health workers’ representatives, develop and implement programmes for regular, free, voluntary, and confidential counselling and testing for HIV and TB, including addressing sexual and reproductive health issues, as well as intensified case finding in the families of health workers with TB.

This statement has several components. The focus of the discussion below will begin with the issue of involving health workers' representatives. The issues of addressing reproductive health issues and intensified case findings in the families of health workers with TB will be addressed afterwards. It should be noted, however, that both phrases in this statement are supported by existing guidelines, as well as evidence from the literature.

Read more about 2.5.1 In conjunction with health workers’ representatives, develop and implement programmes for regular, free, voluntary, and confidential counselling and testing for HIV and TB, including addressing sexual and reproductive health issues, as well as intensified case finding in the families of health workers with TB.

2.12.1 In the context of preventing co-morbidity, provide universal availability of a comprehensive package of prevention and care for all HIV positive health workers, including IPT and CTX prophylaxis, with appropriate information on the benefits and risks

Much of the discussion related to the above statements emphasized the importance of a comprehensive approach. Elaboration on the costs of a comprehensive package are presented below.

Read more about 2.12.1 In the context of preventing co-morbidity, provide universal availability of a comprehensive package of prevention and care for all HIV positive health workers, including IPT and CTX prophylaxis, with appropriate information on the benefits and risks

2.11.1 Provide free HIV and TB treatment for health workers in need, facilitating the delivery of these services in a non-stigmatizing, gendersensitive, confidential, and convenient setting even where there is no staff clinic, and/or the health worker’s own facility does not offer ART.

Makombe and colleagues (2007), visited all 95 ART facilities in the public sector and all 28 ART facilities in the private sector in Malawi, in 2006, constituting the first study from sub-Saharan Africa examining the important interaction between ART scale-up for health workers at a national level. Of the 1024 health workers studied, TB was a common stage-defining condition in 192 (18.8%) health workers, and was significantly more common in ward support staff (23.3%) compared with all other cadres.

Read more about 2.11.1 Provide free HIV and TB treatment for health workers in need, facilitating the delivery of these services in a non-stigmatizing, gendersensitive, confidential, and convenient setting even where there is no staff clinic, and/or the health worker’s own facility does not offer ART.

2.6.2 Key References and Supporting WHO Guidelines

Baleta, A. (2008) Swaziland nurses the wellbeing of its health workers. Lancet. 371;1901-1902.

Charalambous, S., Grant, A. D., Day, J. H., Pemba, L., Chaisson, R. E., Kruger, P., et al. (2007a). Establishing a workplace antiretroviral therapy programme in South Africa. AIDS Care, 19(1), 34-41.

EngenderHealth: Reducing stigma and discrimination related to HIV and AIDS: training for health care workers. New York: EngenderHealth; 2004.

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2.4.2 Key References and Supporting WHO Guidelines

Adams J, Bartram J, Chartier Y. Essential environmental health standards in health care. Geneva, Switzerland. World Health Organization. 2008.

Baussano I, Bugiani M, Carosso A et al. Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures. Occupational and Environmental Medicine. 2007;64(3):161-166.

Churchyard G, Scano F, Grant A et al. Tuberculosis preventive therapy in the era of HIV infection: overview and research priorities. Journal of Infectious Diseases, 2007;196(Suppl 1):S52-62.

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2.2.2 Key References and Supporting WHO Guidelines

Asia-Pacific Network of People Living with HIV/AIDS. (August 2009). Research Finding Highlights: Access to HIV-related services in positive women, men who have sex with men (MSM), transgender (TG) and injecting drug users. Report.

Connelly P, & Rosen S. (2006). Treatment of HIV/AIDS at South Africa's largest employers: Myth and reality. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 96(2), 128-133.

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2.1.1 Introduce new, or refine existing, national policies that ensure priority access for health workers and their families to services for the prevention, treatment and care for HIV and TB.

There are currently no existing guidelines that specifically address the issue of priority access for health workers to services for the prevention, treatment and care of HIV and TB, which, of course, is why the current Guidelines are needed. However, WHO documents do designate health workers as a high risk group (WHO, 2008) As noted in the Rationale for this Guideline, there is an abundance of evidence that HIV-infected health workers are at increased risk as a result of exposures they may confront in the course of their work. (e.g. Buve et al. 1994; Chanda at al. 2006; Corbett at al.

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