Consolidated Guidelines

The evidence suggests that providing access of health workers to HIV and TB prevention, diagnosis, treatment, care and support can best be done on-site at the workplace, provided that the other aspects of concern, particularly confidentially, can be strictly maintained. In an evaluation of the 70 ART delivery sites reported by Charalambous and colleagues (2007b), different sites were used for the services provided - including hospital clinics (8), occupational health centres (29), primary health care clinics (2) and General Practitioner offices (31).

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

Buve, A., Foaster, S. D., Mbwili, C., Mungo, E., Tollenare, N., & Zeko, M. (1994). Mortality among female nurses in the face of the AIDS epidemic: A pilot study in Zambia. AIDS (London, England), 8(3): 396.

Chanda, D., & Gosnell, D. J. (2006). The impact of tuberculosis on Zambia and the Zambian nursing workforce. Online Journal of Issues in Nursing, 11(1): 4.

Coordinated action is often enhanced by the provision of a framework that facilitates the implementation of multi-component guidelines. Although recommendations are placed into a framework, no level of evidence is given for use of this framework. Those implementing these guidelines could decide for themselves whether this framework is useful.

The consultation process specifically addressed implementation. The group suggested that implementation should begin with consultation with the regions regarding how best to promote implementation.

These Policy Guidelines are aimed at accelerating the provision of priority access to prevention, diagnosis, treatment, care and support to healthcare workers with respect to HIV and TB. As is the case with most complex public health interventions, the various elements are mutually synergistic, and failure to implement one of the recommendations can have deleterious effects on proper implementation of others. Thus it is essential that the various statements be seen as a "package", not simply as a series of recommendations that can be individually considered.

Existing guidelines regarding monitoring and evaluation, such as the following, do not specifically address HIV programmes for healthcare workers, nor even the workplace setting generally however WHO does provide some guidance on monitoring and evaluation generally (e.g. WHO's Monitoring and Evaluation Toolkit HIV/AIDS, Tuberculosis and Malaria 2004; FHI/Impact/UNAID. Evaluating Programmes for HIV/AIDS Prevention and Care in Developing Countries, A Handbook for Programme Managers and Decision Makers. 2006.)

The 17 survey confirmed what had often been noted in qualitative studies consisting of interviews and focus group with worker representatives and unions, namely that compensation systems for workers with HIV and TB have been problematic. Although laws are generally in existence that apply to all workers including health workers, they have been difficult to interpret and implement. Most policies have lacked specific reference and guidance to compensation of health workers with HIV sero-conversion/AIDS and/or TB infection from health care settings.