Reacción
2.1.1 Strengthen political commitment, coordination and accountability for collaborative action on TB and HIV
HIV programmes and TB programmes, including their counterparts in other line ministries (for example, in ministries responsible for prison or mining health services), the private-for-profit sector, communities and civil society organizations should work together to provide access to integrated services, preferably at the same time and location. To address other comorbidities and to enhance integrated delivery of health and social protection services, representatives from other programmes within and beyond the health sector may also be considered, for example departments overseeing primary health care, mental health, noncommunicable diseases, nutrition, reproductive, mother, child and adolescent health, smoking and substance use disorders, social support services, and gender.
National coordinating bodies are needed at all levels of the health system to ensure strong and effective collaboration between HIV programmes and national TB programmes and to offer a platform for coordination and synergy among stakeholders within and beyond the health sector. Evidence has shown that coordinating bodies for HIV-associated TB that operate at all levels of the health system with active participation of all relevant stakeholders – including affected people and communities, civil society, and the respective health and social protection programmes – are feasible. Coordinating bodies can also effectively establish political commitment and ownership of collaborative activities at the country level (23, 24). Representation of people at risk of, or affected by, both diseases is essential to ensure effective implementation of integrated services and programme success. In countries where a national multisectoral mechanism for TB has already been established (e.g. as part of the Multisectoral accountability framework for TB (25)), the coordinating platforms for TB and HIV should have clear linkages with this mechanism to optimize synergies including, for example, for financing, social protection and housing. There should also be clear linkages with the national AIDS commissions, which coordinate the multisectoral response to HIV.
A national coordinating body for collaborative TB/HIV activities should have clear and consensus-based terms of reference, including the roles and responsibilities of the national TB and HIV programmes, and of other health programmes and relevant sectors in implementing, scaling up, monitoring and evaluating TB/HIV collaborative activities at all levels. The important areas of responsibility are:
- coordination of collaborative TB/HIV activities throughout the programme management cycle from assessment, planning and resource mobilization, to scale-up and monitoring and evaluation;
- liaison with and reporting to the multisectoral coordination mechanism for TB and the national AIDS commissions; and other coordinating mechanism(s) that may exist on human rights, social protection, and gender, among others;
- facilitation of the involvement of communities and their organizations, civil society, nongovernmental organizations, and individuals; and
- ensuring alignment of advocacy and communication on TB and HIV and other comorbidities.
2.1.2 Support financing and legislation that protect human rights and promote people-centred care
Programmes should work together to ensure financing and legislation to support the delivery of integrated care. This might include:
- scaling up financing models that incentivize the provision of comprehensive services as part of national health financing strategies;
- advocating for change in legislation and financing to allow task shifting and the engagement of peer supporters to deliver human rights-based people-centred care, for example for differentiated service delivery;
- building capacity among civil society organizations to monitor and strengthen implementation of laws to address stigma and discrimination and other forms of social exclusion; and
- advocating for decriminalization of drug use and strengthening linkages with prison services to ensure fulfilment of the human right to equitable access to care for HIV-associated TB and other related comorbidities for prisoners.
Since legislation and financing often lie outside the purview of the TB and HIV programmes, it is essential to develop strong partnerships with stakeholders from outside the health system, including funding agencies, to advocate for and assist in addressing these areas. This may include, for example, advocating for legislation that allows prescription of opioid agonist maintenance therapy (OAMT), or advocating for financing that allows implementation of social protection. Moreover, the coordinating platforms for TB and HIV should also liaise with the coordinating platform for the Multisectoral accountability framework for TB (25) and with the National AIDS Council to optimize synergies.
2.1.3 Ensure meaningful engagement of civil society and affected communities at all stages of planning, implementation, monitoring and evaluation
Expanding collaborative TB/HIV activities beyond the health sector is crucial, through meaningful involvement of communities, civil society organizations and individuals in the governance and decision-making, planning, implementation and monitoring of TB/HIV activities at all levels. People at risk of, or affected by, TB and HIV, as well as community stakeholders (e.g. opinion and religious leaders), community-led and community-based organizations working on advocacy, treatment literacy and community mobilization are key actors in generating demand for people-centred services at all levels of care. Engagement and support, including financial support, for civil society and affected communities is therefore critical. Advocacy targeted at influencing policy and sustaining political commitment, programme implementation and resource mobilization is needed to accelerate the implementation of collaborative TB/HIV activities. Programmes and stakeholders should work together to empower affected people and communities, and civil society, to ensure they are a continuum of the health system and can be actively, formally and regularly engaged in shaping the agenda on HIV-associated TB. This includes from governance, decision-making and planning, to monitoring and evaluation, as well as in advocacy for scale-up of non-discriminatory, high-quality care for HIV-associated TB and other comorbidities, and for availability of related resources through domestic and external sources.