Via Libre, the Alliance linking organisation in Peru, is: ‘Increasing access and promoting integration of the response to TB/HIV co-infection’.
Peru has a concentrated HIV epidemic and the known rates of TB/HIV co-infection are low at 2.1%, although it is expected that actual rates are much higher. Most people affected by TB are 20-59 year olds, i.e. Peru’s economically active population.
Some significant progress has been made around HIV and TB in Peru. The introduction of free ARVs in 2004 led to a reduction in HIV and TB related deaths However since 2006 death rates have remained stable due to late diagnosis of TB.
Despite this, access to TB services has improved. In 1990 only 25% of the Ministry of Health’s establishments were involved in testing and treating TB; by 2007 access to free TB testing and treatment was available to all. It is estimated that more than 90% of cases of TB are being identified, and around 92% of those who undergo treatment are cured.
However, this work has been compartmentalised and few explicit efforts have been made to understand and promote the need to integrate HIV and TB services. Via Libre’s project is demonstrating the benefits of an integrated approach.
Typically HIV tests are not free, even for
patients diagnosed with TB. Through Via Libre’s clinic, using their
mobile unit, and through partners ASPAT (the Association of People
affected by TB) and the Regional Health Board DIRESA, Via Libre has
introduced fast-testing for TB, and free HIV testing to people affected
by TB in Callao, where the project was piloted.
People affected by TB are stigmatised due to the lack of basic information among the general population on how to prevent TB infection, so Via Libre’s project provides this information at community level by strengthening community organisations and providing training to health care workers and community leaders.
This was piloted in Lima, Callao, Ica and Lambayeque through partners; ASPAT(Callao); Despertar (Ica) and Viviendo en Positivo (Lambayeque).
State health centres do not usually have adequate facilities to prevent TB infection; increasing the risk to health care providers and service users. The project offers training to health care providers to reduce infection in hospitals. It also advocates for integrated support for patients, including psycho-emotional care, nutritional advice and information about side-effects and co-infection.
Encouragingly, the Multisectoral Strategic Plan for the National Response to Tuberculosis in Peru 2009 – 2018 was recently endorsed by a wide range of sectors of the state, civil society and people affected. As well as raising awareness of HIV/TB co-infection, partner organisations are providing advocacy training to health care providers and community leaders to get TB and HIV on technical and political agendas, at national level.
Typically HIV tests are not free, even for patients diagnosed with TB