1. PERSPECTIVES FROM THE FIELD DR LYDIA MUNGHERERA TASO (The Aids Support Organisation) UGANDA REVERSING THE TIDE OF TB

2. Introduction The HIV pandemic presents a massive challenge to the control of TB all levels. TB is one of the most common causes of morbidity in people living with HIV/AIDS. By the end of 2000, about 11.5 million HIV infected people were co-infected with TB. Uganda is one of the world’s 22 high burdened countries with TB. Uganda has an estimated annual risk of infection of 3% equivalent to 150-165 new smear positive cases per 100,000 populations per year or 300-330 total TB cases per 100,000 per year.

3. Background of TASO TASO was founded in 1987 by a group of 16 volunteers spearheaded by Noreen Kaleeba and her husband the late Christopher Kaleeba (R.I.P) The vision was to take care and support people living with HIV/AIDS so that they can live and die in dignity

4. TASO SERVICES HIV/AIDS counselling Medical care Social support Capacity building Advocacy and networking Community mobilisation,education and senstisation Regionalisation Programme support and evaluation

5. Role of Taso Drama Groups TASO drama groups are made of positive members who go out and sensitize the community about the epidemic and common opportunistic infections like TB

6. Medical care The medical department has activities to promote medical care like: Center and outreach clinics TB follow up Home based care Support and supervision to community nurses

7. Training at TASO Centres Training takes place at the centers to give staff and community volunteers more knowledge of how to care and support people living with HIV/AIDS and TB

8. TB Care and support TB care and support is proper management of a TB client both at the facility and in the community. It is aimed at prevention of spread to the community and complete cure of the infected. It involves screening,counselling,drug initiation and follow up. Screening of HIV is done at the same center and patients are treated for both diseases

9. COMPONENTS PREVENTIVE MEASURES TB health education talks during community gatherings at the center and outreaches. Individual health education during triage,consultation,dispensing Follow up and monitoring

10. COMPONENTS PROPER MANAGEMENT Early identification and screening Treatment initiation as per National TB Leprosy Program (NTLP) guidelines Relevant TB counselling and Accurate recording

11. CB DOTS MODEL DEFINITION: Community Based Direct Observed Treatment Shortcourse is supervised tablet swallowing in the community PEOPLE INVOLVED IN THE COMMUNITY: 1. clients and care givers 2. AIDS community workers (ACWs) 3. Community nurses 4. Home care team who report to the TB nurses

12. DOTS FOLLOW UP Identification of homes for periodic home visits depending on severity,appointment compliance,prognosis and workload. House hold health education on hygiene, nutrition, prevention, stigmatisation and adherence. Identification of a treatment supporter for DOTS initiation. Support and supervision of caregivers DOTS and community nurses CB DOTS. Field Officers who monitor adherence to ARVs complement the follow up of TB treatment in the community

13. ROLE of Community Health Workers Community mobilization for TB and HIV Coordinate TB care and support activities Support update of the unit TB register Ensure a continuous drug stock Do TB follow-up for repeat sputum smears Ascertain correct discharge from treatment

14. ACHIEVEMENTS Reduction in the TB epidemic and reduced mortality of Aids patients Follow up has helped with adherence to treatment Raised community awareness Reduction of morbidity and mortality TB and HIV programmes have begun to complement each other Involvement of people living with the two diseases as peer educators

15. CHALLENGES Inadequate TB/HIV programs in government health facilities “Pill Burden” of TB/HIV makes it difficult for patients to adhere Absence of drugs for MDR and proper diagnostic tools in most health centers Interaction between ARVs and anti-TB drugs Stigma in families and in the community Lack of skilled manpower Scattered populations make it difficult to identify homes where TB patients are living

16. Unique Obstacles to Rural TB/HIV Care Minimal existing health infrastructure and personnel – very limited access to lab testing Dispersed population with limited access to transportation Extreme poverty with minimal access to electricity, sanitation, clean water Potential difficulty with adherence, potential for development of viral resistance

17. WAY FORWARD Strengthen the collaboration of TB and HIV/AIDS services at all levels Professional skills-refresher workshops Reduce stigma amongst health workers Improve community mobilization skills Creating partnerships with other stakeholders Search for new diagnostics and drugs which make adherence easier for patients

18. ACKNOWLEGMENT ACKNOWLEGMENT I would like to acknowledge all the staff of TASO in the community and at the centers. I especially want to acknowledge the TB nurses and field officers for follow up of patients on treatment.

19. I want to thank the TB Alliance for recognizing the need for community involvement and inviting me to this meeting