Comorbidities

This section of the operational handbook was prepared by Ernesto Jaramillo, Farai Mavhunga, Marzia Calvi and Annika Sweetland (consultant) from the World Health Organization (WHO) Global Tuberculosis Programme Department (GTB), and Aiysha Malik and Mark van Ommeren from the WHO Department of Mental Health and Substance Use (MSD), under the overall direction of Tereza Kasaeva, Director of the GTB department and Dévora Kestel, Director of the MSD Department.

Background and Objective:

These Policy Guidelines are aimed at accelerating the provision of priority access to prevention, diagnosis, treatment, care and support to healthcare workers with respect to HIV and TB. As is the case with most complex public health interventions, the various elements are mutually synergistic, and failure to implement one of the recommendations can have deleterious effects on proper implementation of others. Thus it is essential that the various statements be seen as a "package", not simply as a series of recommendations that can be individually considered.

The evidence for this statement was reviewed in-depth for the recent WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households and on infection control generally. and therefore will not be elaborated upon extensively here. These WHO infection control guidelines must be observed in their own right as well as being an essential component of improving health worker access to prevention, treatment, care and support for HIV and TB.

The Guideline Group aimed to gather evidence on the policies and legislation that exist in 34 countries, with 4 of 6 WHO regions responding prior to the drafting of the Synthesis report (Yassi et al., 2009). The purpose was to identify gaps in policy and barriers to implementing related policies related to improving healthcare worker access to HIV and TB services. Overall HIV and TB prevalence determined the number of countries to be surveyed for each region. Within each country, the WHO HIV officer liaised with their respective Ministry of Health to facilitate collection of data.

The Five Country Study by Corbett (2007a) provides high quality evidence relevant to developing guidelines. The methodology included interviews with 938 health workers from 50 facilities across five African countries (Ethiopia, Kenya, Malawi, Mozambique, and Zimbabwe), 30 of which were selected through random cluster sampling, with the others selected through purposive selection seeking facilities with best practices.