HIV/AIDS and Tuberculosis Global Program

Integrating services for greater impact

PATH meets the intersecting health needs of people with HIV/AIDS and TB

People with HIV/AIDS and tuberculosis (TB) face a host of health problems and risk factors that too often go unmet in health systems designed to address only one disease or the other. PATH is at the forefront of integrating services for both of these diseases and others. Integration helps improve diagnosis and treatment, links people with the services they need, and ensures the cost-effective use of limited resources across multiple sectors.

Man sitting next to microscopePATH works with numerous countries to incorporate broad-ranging integration approaches and services into health care systems. These approaches range from addressing co-occurring infections and creating more efficient referral systems to mobilizing high-level stakeholders for new policies. As a result, clients experience a more seamless continuum of care, whether at clinics or in their communities; health care providers can make a greater impact on the health of the people they serve; and health systems can make smarter investments.

Expanding TB/HIV service delivery

Each year, nearly 1.4 million people die from TB, a curable disease. This global health crisis is partly fueled by the HIV epidemic: TB is the leading cause of death among people living with HIV. PATH is a global leader in developing and partnering on sustainable, integrated solutions to combat TB. In Africa, we have proven that integrating TB and HIV services can significantly increase diagnosis of both diseases. For example, 98 percent of TB patients in project-supported sites in the Democratic Republic of Congo now receive HIV testing, a dramatic increase from the national average of 24 percent.

In Ukraine, where TB rates are especially high, PATH has implemented comprehensive approaches to address the disease for more than a decade. We have fostered collaboration between the national and regional TB and AIDS programs and trained health providers to manage both diseases. These collaborations led to an updated national TB/HIV policy, regional TB/HIV coordination councils, and the engagement of local nongovernmental organizations in reducing stigma and detecting TB in vulnerable groups. PATH also pursues innovative approaches to reach high-risk, underserved populations.

Addressing gender as a risk factor for HIV

Gender-based violence affects both men and women and both boys and girls: it places individuals at higher risk for contracting HIV and impedes access to diagnosis and treatment. PATH is an internationally-recognized leader in advancing effective approaches that transform inequitable gender norms and prevent gender-based violence. From China to Nicaragua to Ethiopia, we engage both men and women in promoting gender-equitable behaviors and we advance solutions for health issues that disproportionately affect women and girls.

Doctors sitting around tableWe also conduct rigorous research and evaluation to understand what works and ensure that programs are evidence-based, including around gender. Our widely used Gender Equitable Men Scale helps programs measure changes in men’s attitudes and behaviors around gender norms, HIV risk, and violence. In Senegal, we are drawing on our in-depth experience with community-based participatory methods to evaluate a Community Empowerment Program led by our local partner, Tostan. Understanding the program’s effect on gender-based violence, women’s empowerment, and related health issues will help future work have even greater impact.

Finding and treating TB in children

While TB is curable, it kills more than 60,000 children each year due to underdiagnosis and poor management. In most countries, for example, efforts to find, diagnose, and treat TB focus only on adults. PATH is changing this by raising awareness and developing policies, guidelines, and trainings to manage TB among children. In Tanzania, we worked closely with the Ministry of Health and Dartmouth College to develop and introduce national pediatric TB guidelines and a comprehensive training curriculum for improved diagnosis, treatment, and care. In Kenya, we are reducing deadly TB/HIV co-infections in children by conducting TB screening programs for children with HIV or HIV-positive mothers. No children who have started isoniazid preventative therapy have since developed TB.

Tackling the co-epidemics of TB and diabetes

Diabetes triples the risk of developing TB, and rates of TB are higher in people with diabetes than among the general population. This has created an urgent need for diagnostic tools and procedures for people with both diseases—and PATH is on the cutting-edge of identifying and piloting solutions.

Our approach to these intersecting epidemics is based on more than 30 years of experience developing and introducing health technologies. Our current portfolio brings technological innovation to the detection and management of TB in people with diabetes and vice versa. For example, PATH is partnering with the Mexican Ministry of Health to pilot a bidirectional screening model using two novel, noninvasive technologies alongside existing clinical TB and diabetes screening methods. Combining these promising health technologies with strong health systems to combat communicable and non-communicable diseases can have sustained impact on the health of people around the world.

Leveraging HIV and TB services for better diabetes care

While the burden of noncommunicable diseases continues to grow worldwide, most people in sub-Saharan Africa still don’t have access to prevention, care, and treatment services. Health systems are often too overstretched to provide additional, long-term services needed to care for people who also struggle with other chronic conditions like diabetes. As part of the Labs for Life initiative, PATH is partnering with the pharmaceutical company BD to use existing HIV and TB laboratory services to better address diabetes in Ethiopia.

All photos: PATH.