Meeting the global challenge of HIV/AIDS and TB

A multifaceted approach to addressing intertwined epidemics

PATH develops and implements innovative, evidence-based interventions to reduce the toll of HIV/AIDS and tuberculosis (TB), including multidrug-resistant TB and TB/HIV co-infection. Our multifaceted approach addresses the full spectrum of issues that fuel these intertwined epidemics. Our work includes changing behaviors to reduce risk, using low-cost technologies to improve services, and strengthening health systems and community responses to improve outcomes. Through collaboration with public and private partners, we are helping to extend and improve the lives of millions of people infected and affected by TB, HIV/AIDS, or both conditions.

Reducing risk, improving access

To help control HIV/AIDS, we focus on reducing risk and improving access to services. For TB, we strive to strengthen primary prevention and increase universal access to high-quality diagnosis and treatment. Key strategies driving our work in Africa, Asia, Eastern Europe, and Latin America include:

• Addressing social and structural factors—such as issues related to gender, stigma, and poverty—that limit the effectiveness of TB and HIV/AIDS programs.
• Providing sound, evidence-based technical support to improve program performance.
• Strengthening the capacity of local partners to deliver services.
• Designing and applying innovative communication and advocacy strategies to more effectively reach key audiences.
• Contributing to the evidence base on TB and HIV/AIDS through operations research and rigorous monitoring and evaluation.

Operations research and monitoring and evaluation

PATH’s operations research helps decision-makers identify and evaluate potential solutions to health problems and then select the best option. Through use of advanced monitoring and evaluation techniques, we help track project implementation and outputs, inform management decisions, facilitate effective and efficient use of resources, and identify successful program strategies and approaches.

In Cambodia, for example, PATH has used operations research to improve detection of TB cases. Research revealed that referrals of people with suspected TB from pharmacies to diagnostic centers led to a high yield of TB cases. The national TB control program subsequently increased pharmacy engagement.

Behavior change and advocacy

Our interventions using behavior change communication and advocacy, communication, and social mobilization have reduced health risks and improved services in communities, schools, workplaces, and other settings.

In Kenya, for example, activities to reduce HIV risk and other health issues among youth have included community-based discussions with parents and key male community members, theater performances, and a scouting program. The interventions have reached hundreds of thousands of youth and family members in Kenya, with positive effects on self-esteem and sexual behaviors.

To improve TB control, PATH works closely with the Stop TB Partnership and other partners to help countries use advocacy, communication, and social mobilization to fill gaps in programming.

Community-based responses

Strengthening community-based responses to the TB and HIV/AIDS epidemics so that people can participate in collectively defining and addressing their own health challenges is vital to our work. In Tanzania, we’ve trained community-based sputum-fixers to expedite TB diagnosis and treatment and improve adherence to long-term therapy. In Ethiopia, we’re increasing the capacity of civil society organizations to reach greater numbers of people with interventions for HIV/AIDS, such as home-based care. And in the Democratic Republic of Congo, we’re collaborating with associations of former TB patients (e.g., Club des Amis Damien) to fight the disease. We’re also working with local groups from the ground up, through Champion Communities, to engage Congolese citizens in finding ways to integrate and deliver supportive HIV/AIDS services to those who need them.

Gender norms and stigma

Gender inequity and stigma contribute to the spread of HIV/AIDS and reduce access to services for HIV/AIDS and TB. PATH has worked with the United Nations Trust Fund to End Violence against Women to address gender issues in Africa, Asia, and Latin America and the Caribbean. Our technical assistance has focused on assessing a range of promising strategies—including community mobilization, engaging men, capacity-building for service providers, and advocacy for strengthened policies—to reduce women’s vulnerability to violence and HIV infection.

With our partners, we’ve also implemented and evaluated efforts in Ethiopia, Namibia, and Tanzania that have increased support for more equitable gender norms among young men and decreased violence against women.

Banner photo: PATH/Mike Wang.