Conclusions and recommendations – first draft 4th TB/HIV Working Group Meeting, Addis Ababa, September 20-21, 2004 Conclusions and recommendations – first draft Paul Nunn on behalf of the Secretariat GLOBAL PARTNERSHIP TO STOP TB

Advocacy Collaboration Technical support

Advocacy Money is flowing but bottlenecks in the money supply continue. These include: Donor conditions, especially financial accountability, slowing rate of flow, especially of GFATM eg Sudan, Iran Donor politics, interference, and poor management Poor financial management at district level Donors bypassing government, direct to civil society, community groups, causing problems of coordination, and disempowering national bodies Donors should agree to national level harmonisation and avoid parallel approaches eg ART treatments with generics and branded drugs in the same country Concerns about sustainability and exit strategies with need for lifelong treatments and limited project life WG Chair requested to bring these concerns to STOP TB Coordinating Board, GFATM Executive Board and WHO, and remind donor agencies of promises to take risks and avoid business as usual

Advocacy - II The WG welcomes the inclusion of activist and community groups in the TB/HIV struggle. The Secretariat and all partners are urged to engage these groups more, especially in advocacy for country level action The WG emphasises the importance of new diagnostics and new drugs, particularly in the context of HIV coinfection. The Chair is urged to reinforce these messages to the Coordinating Board and the Diagnostics and New Drugs WGs, and work with HIV advocates to make their concerns plain to these groups, as well as funding agencies

Collaboration - I Conceptual differences between the DOTS approach and ARV scale up: the former based on guidelines and nationally accepted strategies, the latter on human rights approach and both strengthening health services. These differences likely to impede collaboration. ARV access is a human right. WG advises Stop TB and HIV Departments in WHO to address these differences - share the strengths, drop the weaknesses. Stop TB is advised to communicate the flexibility and all inclusiveness of DOTS better. STB in addition should address the field performance of treatment for smear negatives.

Collaboration - II Lack of human resources is a major constraint to scale-up of ART and collaborative TB/HIV activities, as it is throughout the health sector and beyond eg the dearth of finance and administrative staff. Salaries and incentives need particular attention. The WG Chair and secretariat are urged to link with other efforts addressing this issue, eg in WHO/EIP and the Rockefeller Foundation, to put the case of TB/HIV and involve WG members in studying the problem and working towards solutions. Report back to next WG The issue of HR, and particularly remuneration, should be linked with advocacy for increased TB/HIV services.

Technical support - I The 12 TB/HIV elements of the WHO TB/HIV policy are now the standard of care, but insufficiently implemented. In addition, the expanded DOTS framework has been insufficiently communicated to policy makers and health workers. WHO, both STB and HIV Depts should more actively promote the current strategy, supported by the STOP TB Partnership. Countries should regularly and transparently monitor their own performance to ensure that they are getting the best results from their TB/HIV activities Secretariat to continue technical assistance for monitoring of country performance with feedback to WG and countries themselves

Technical support - II In European region TB/HIV co-infection is closely linked with substance abuse and male dominance WHO/EURO are urged to explore this issue, prepare an analysis of the steps required to implement such an approach in FSU, and present it to the Core Group early 2005 East European states experience high rates of both MDR-TB and HIV and offer the spectre of an HIV-fuelled epidemic of MDR-TB The secretariat is asked to urgently explore the impact of HIV on transmission of MDR, in high MDR settings, estimate the size of the problem and the necessary steps to be taken