PEPFAR evaluation: TB-HIV integration not up to par

• Overall message: PEPFAR hasn’t been doing as well on TB-HIV as it has on other clinical HIV services. TB-HIV integration is not where it needs to be.

-- “progress in this area has come more slowly than in other clinical services for HIV, and challenges persist in achieving adequate coverage” (pg. 216) 

-- In 2010, only 49% of PLHA in PEPFAR programs were screened for TB. This fell short of their goal of 68%. (pg. 240)

• What is preventing better TB-HIV integration? (pgs. 240-242)

-- Separate donor funding streams for TB and HIV prevent integration. One interviewee explained “programs have a positive view of integration until they are competing for funding” (pg. 242)

-- Lack of diagnostic capabilities and lab capacity

-- Lack of integrated facilities; Loss to follow-up for co-infected patients in areas where programs are poorly linked

-- Patient resistance to getting tested for HIV, including a desire among some patients to complete TB treatment before starting ART

• Other notable issues

-- TB-HIV collaboration is good at the national and provincial level but variable at the district level

-- Despite listing IPT as ‘cost-saving’ and effective, PEPFAR has no indicators for IPT (pg. 236 and 238)

-- Drug stock outs were reported as a major problem in many PEPFAR countries (pg. 412)

• Recommendations

-- “The best practices for integrating services, such as HIV and TB, reproductive health, and primary care, need to be identified, evaluated, and scaled up.” (pg. 367)

-- TB and HIV clinics should be co-located to prevent loss to follow-up; it works better than referral systems. (pg. 438)

By Mandy Slutsker, MPH
Senior Associate
ACTION | RESULTS Educational Fund
www.results.org | www.action.org