Dialogue on HIV and TB Project
Implemented by: AIDS Foundation East-West (AFEW), Population Services International (PSI), Project HOPE, Kazakh Association of People Living with HIV/AIDS
Duration: February 2010 – September 2012
The Central Asian Republics have not been as hard hit by the HIV epidemic when compared with Eastern Europe. However, given their location along the drug trafficking routes between Asia and Western Europe, there is cause for concern as new cases continue to rise across the region. As of the end of 2009, in the four Central Asian Republics where AFEW has carried out programme activities (Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), over 30,000 individuals have been officially registered as living with HIV, with experts putting the real figure close to 50,000 cases.
These figures are expected to increase further in the years to come due to the rapidly growing number of drug users. At the same time, low rates of TB detection and poor TB treatment adherence are helping to fuel the growth of the region’s HIV/TB epidemic. The interaction of these epidemics in the region has serious implications for public healthcare, since statistically a quarter of deaths among TB patients is HIV-related and people living with HIV are 20 more likely to develop TB . In the Central Asian context, there is a clear need not just to step up HIV prevention, treatment, care and support, but also to establish an integrated HIV/TB response.
In order to do just this, AFEW and its partners have launched a five-year Dialogue on HIV and TB Project. AFEW is implementing project activities in Kazakhstan, Kyrgyzstan and Tajikistan. All managing organisations have a strong history of conducting outreach work with people at risk of HIV or affected by HIV in Central Asia. This new project aims to scale up these best-practice activities to the regional and national levels.
The overarching aim of the Dialogue on HIV and TB Project is to reduce HIV and TB among key populations (injecting drug users, sex workers, migrants, men who have sex with men, prisoners and people living with HIV). Specifically, activities will evolve around three pillars: evidence-based planning, targeted outreach services and regional and national working groups.
Evidence-based planning: One of the biggest problems that organisations face when addressing HIV and TB in this region is the lack of up-to-date information and accurate data on people in target groups. Throughout the project, the consortium will conduct continuous research among target groups in all four countries to establish why certain behaviours and situations persist (for instance, why some drug users continue to share needles or why some people with TB do not access treatment). As evidence is collected and regularly updated, the consortium will amend its activities in each country.
Targeted outreach services: Where research suggests that essential services are absent or inadequate for certain target groups, the consortium will work with local governments and civil groups to introduce or improve them. The project focuses specifically on outreach work and these services will include:
- Informational materials: Leaflets, websites and other informational materials for target groups and professionals will be adapted and/or developed to address barriers to HIV and TB prevention and treatment.
- Communications with key populations: This includes setting up one-to-one sessions, small group discussions, peer education and interactive events at medical centres, NGO sites and in prisons. A combination of professional outreach workers and community-based volunteers will help conduct this work.
- Condom distribution: Through cost-share schemes, condoms and information on correct usage will be distributed among clients at project sites.
- Motivational interviewing: Project partners will be trained in conducting this client-centred counselling style which elicits behaviour change by helping clients explore and resolve the attitudes and motives for risky behaviours.
- Client management: By developing client management and proactive referralshe between different streams of social and medical care, the project will increase take-up of voluntary counselling and treatment (VCT), testing and treatment for sexually transmitted infections (STIs), drug rehabilitation and TB testing and treatment services.
Regional and Country Working Groups: A regional committee and four country-level committees will be formed to oversee the programme’s development, trouble-shoot problems that occur and offer expert advice on implementation. Participants will include people living with HIV and TB patients, civil society leaders, managers of HIV and TB projects, as well as representatives of international agencies (such as USAID, UNAIDS, WHO and the International Organisation for Migration (IOM) and national governments. Members of the committees will be called upon to promote the projects methods, approaches and results in their networks.
While collaborating with its partners on the key areas outlined above, AFEW will play a special role in leading the programme’s prison activities based on its long experience of implementing HIV projects in the region’s penitentiary systems. AFEW will also train its partners in the client management approaches that it has successfully implemented in both the civil and prison settings of Central Asia.
Overall, the Dialogue on HIV and TB Project is designed to be highly flexible in its activities in order to allow space for fast adjustments to changing environmental and political contexts. Throughout the five-year period, target group coverage and geographic reach will be expanded, modifying activities based on lessons learned and data from research, monitoring and evaluation.