Community systems strengthening needed to end HIV, TB

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As the global HIV community gathers this week in Durban, South Africa for the International AIDS Conference, their focus should be on strengthening community-led responses, along with health systems strengthening to reach UNAIDS’ goal of testing 90 percent of people living with HIV, getting 90 percent of them on antiretroviral therapy, and suppressing the virus in 90 percent of those on treatment, Dr. Harry Hausler said when he spoke with Science Speaks at the RESULTS conference.

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Dr. Harry Hausler

Training and equipping more community health workers and peer outreach and education workers is the answer to reaching vulnerable populations and driving down the HIV epidemic, Hausler, who is the CEO of the TB/HIV Care Association in South Africa, said. A community-led response to HIV and tuberculosis in particular will also strengthen other infectious disease responses, Hausler said, including hepatitis, which new research shows to be one of the world’s leading infectious disease killers.

Effective community-led efforts for responding to HIV and other infectious diseases grew out of the community-based efforts of tuberculosis control, Hausler said, which allowed for client-centered services to be delivered where people live. The Care Association has employed such community-led interventions since the 1990s, when they began doing directly observed therapy for tuberculosis control.

Now, the Care Association focuses on peer-led service delivery, employing former and current commercial sex workers and injection drug users to deliver services to those key populations. Most importantly, peer-led service delivery, Hausler said, mobilizes communities and builds trust, reducing stigma and discrimination against marginalized communities will sensitizing health workers to their needs.

Greater decentralized management is needed in health responses, “so people can stay with their families and get back to work,” Hausler said.

Since 2007, the Care Association has received funding from the President’s Emergency Plan for AIDS Relief to for their peer-led, mobile health services program. Over the past decade, the Care Association has used their community-based efforts to reach two million people with HIV testing and care, including 20,000 commercial sex workers. The Association has also used funding from the Global Fund to Fight AIDS, TB and Malaria to reach 277,000 prisoners with tuberculosis screening, Hausler said.

Governments and donors need to collaborate more with civil society to develop and deliver community-based programs, Hausler said.

“Civil society knows about these communities,” he said, adding, “They know where to go.”

Governments are not investing in community-based services, he said. Governments are investing in other aspects of health systems strengthening, but the resources just aren’t there to strengthen community systems, and that needs to change, Hausler said.

Stay tuned to Science Speaks as we live-blog from the International AIDS Conference.

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