What Works for Women and Girls

mortality of HIV-positive people recently diagnosed with TB (WHO, 2006c). In 2007, onlysixteen percent of people with notified TB knew their HIV status, resulting in low rates ofaccess to co-trimoxazole prophylaxis and antiretroviral therapy for people living with HIV andTB (UNAIDS, 2009e). A pilot cross-referral initiative instituted between VCT centers andtreatment facilities in four districts of Maharashtra, India, found that from 2003 to 2004, 3%of VCT patients were diagnosed with TB and 24% of TB patients were found to be HIV-positive(Central TB Division, TB India, 2007 cited in Shetty et al., 2008b). Once a patient has beendiagnosed with TB, HIV testing and counseling should be offered if the HIV status is unknownor was previously reported as negative (Harries et al., 2009a: 7). A study of three health caresettings in Kinshasa, Democratic Republic of Congo found that provider-initiated HIV counselingand testing among TB patients resulted in greater uptake of HIV testing (Van Rie et al.,2008). Likewise it is important that people living with HIV be regularly screened for TB and tohave access to timely and accurate diagnosis so that the appropriate treatment is administeredfor TB and HIV.“Because dual infection with HIV and tuberculosis poses a life-threatening diagnosticand therapeutic dilemma... HIV programs must include capabilities for diagnosis, treatment,and prophylaxis of tuberculosis. Tuberculosis treatment programs should be supported as animportant point of entry for HIV testing and consideration for HAART. It is critical to overalltreatment success that these coexisting epidemics be addressed in parallel” (IOM, 2005: 6). Itis estimated that half a million people with HIV/AIDS could be reached through existing TBprograms (Kim, 2004 cited in IOM, 2005: 103).WHO has developed the Interim Policy on Collaborative TB/HIV Activities (WHO, 2004b,http://whqlibdoc.who.int/hq/2004/who_htm_tb_2004.330.pdf) that recommends twelveactivities that can be taken up by the health sector, civil society and governments to address theoverlapping epidemics. At a minimum, programs must be scaled up that:Offer HIV testing and counseling to all TB patients;Screen all people living with HIV for TB disease;Provide TB treatment or preventive therapy to all co-infected people;Provide co-trimoxazole and antiretroviral treatment to all TB patients with HIV; andEnsure TB infection control in all health care facilities and high HIV prevalence settings.Despite overwhelming evidence, many public sector health programs have failed to implementthe activities that address reducing the burden of TB and HIV in populations affected byboth diseases (Dong et al., 2007; WHO, 2009i). In many countries, the national TB programand the national AIDS control program run as parallel systems without a mechanism to link toone another (Reid et al., 2006; Williams et al., 2008). HIV programs play a vital role in identifyingthose with TB and interrupting transmission through active TB case finding and implementinginfection control measures (Reid et al., 2006). Unfortunately, “delays with the scaleupof antiretroviral treatment have exacerbated the tuberculosis epidemic…and thousands ofpreventable deaths” (Chopra et al., 2009c: 3).WHAT WORKS FOR WOMEN AND GIRLS273