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TB-HIV Coinfection Education and Community Mobilization Workshop, 2002

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A Satellite Meeting Held in Conjunction with the STOP TB DOTS Expansion Working Group &
The 33rd International Union Against Tuberculosis & Lung Diseases (IUATLD) Conference

Montreal, Quebec, Canada – 5 October 2002

Executive Summary

Workshop Composition & Format

On October 5, 2002, Treatment Action Group (TAG) sponsored a TB/HIV Coinfection workshop in Montreal attended by 29 people. Eighteen participants were from the developing world, principally from sub-Saharan Africa, but also from Brazil, eastern Europe and India.

Participants were recruited from countries with high HIV prevalence and tuberculosis incidence. Applicants were prioritized according to their work in HIV and/or TB, involvement at community level, and history of advocacy activities. The workshop generated a great deal of interest. TAG was only able to accept less than a quarter of the applications. Presenters and moderators were drawn from public health agencies, including WHO and the CDC, and groups with successful histories of community mobilization and advocacy.

The workshop included presentations on tuberculosis epidemiology, natural history, and treatment; HIV disease and treatment; strategies for coordinating TB and HIV medical care and services; and community mobilization models and strategies.

Participants broke out into four small groups to discuss opportunities and challenges in addressing TB/HIV coinfection in their countries.

In the days following the workshop, participants attended the 3rd Stop TB DOTS Expansion Working Group public meeting and TB-related sessions at the 33rd International Union Against Tuberculosis and Lung Diseases (IUATLD) conference. Before returning home, participants met to share what they had learned and to discuss plans for follow-up. 

Follow-up Ideas & Plans

  • Botswana – working with a network of ASOs to develop a community mobilization plan on TB/HIV coinfection; discussing TB/HIV at October NGO meeting. 
     
  • Brazil – planning with Rio de Janeiro TB control program and IUATLD for a regional TB/HIV meeting in 2003.
     
  • Estonia/Eastern Europe – incorporating TB into HIV trainings and meetings.
     
  • India – working with the Network of Maharashtra PLWHAs on promoting TB screening for HIV infected individuals, disseminating information to community members on TB/HIV coinfection; identifying needs for information, education and communication (IEC) materials, including translations of existing information.
     
  • Kenya — developing a proposal for community mobilization around early TB diagnosis and treatment; working on planning a TB/HIV component for the 13th ICASA meeting in September 2003.
     
  • Malawi — developing a plan for isoniazid (INH) and cotrimoxazole prophylaxis through a home based care program; planning to integrate TB and HIV care (including HAART) at the district level; creating an action plan for a coordinated country-level response to TB/HIV and consulting with other TB and HIV clinicians and researchers.
     
  • Zambia – holding a TB/HIV concert event attended by 400 students at a teachers college; initiating weekly outreach activities on TB/HIV coinfection; planning a four-day workshop to train outreach workers on TB/HIV coinfection; incorporating TB/HIV health education into a research project on delays in TB diagnosis and initiation of treatment.  


Workshop participants will stay in contact through an email list designed to encourage information sharing and the discussion of strategies. TAG will track the on-going activities of workshop participants and provide support and feedback on advocacy efforts.

TB/HIV Coinfection Education and Community Mobilization Workshop

Introduction and Background 

In recent years the link between tuberculosis and HIV has gained incReasing attention. TB accelerates HIV progression, and HIV increases the risk of developing active TB disease. The global TB and HIV epidemics fuel each other, and together make up the leading infectious causes of mortality around the world. Conventional TB control efforts are inadequate in high HIV prevalence countries, and TB is a leading cause of mortality in people with HIV.

  1. 11% of all new adult TB cases were attributable to HIV infection in 2000 - in Africa the figure is 31%.  
  2.  Of 1.9 million deaths from TB in 2000, 18% were attributable to HIV.
  3. TB was the immediate cause of 15% of all adult AIDS deaths in 2000, of which only about one third received TB treatment.
  4. TB/HIV co-infection rates exceed 5% of the adult population in nine African countries. 

—An Expanded DOTS Framework for Effective Tuberculosis Control, Stop TB/WHO, 2002 

After years of approaching TB and HIV through "a dual strategy for a dual epidemic," the World Health Organization has recently begun to promote its "Strategic Framework to Decrease the Burden of TB/HIV". WHO and the Stop TB Partnership have established a TB/HIV Working Group, which is acting—through projects such as the ProTEST initiative—to develop better models for dealing with TB/HIV coinfection. Public health officials, researchers, and advocates are calling for increased coordination between national TB and HIV control programs, but few models exist and many operational questions have been raised. Moreover, TB and HIV programs in high incidence countries are each struggling to mobilize resources to expand DOTS coverage and HIV care, including antiretroviral therapy.

However, a number of recent developments point to new opportunities:

  • Increased international donor support—particularly with stablishment of the Global Fund to Fight AIDS, TB and Malaria—has begun to address resource gap.  
  • Increased research efforts - including the CREATE initiative led by the Johns Hopkins Center for TB Research - are being initiated to help clarify some of the clinical and operational issues.
  • Within the Stop TB Partnership, a new emphasis on information, education, and communication (IEC) activities and on social mobilization has begun to identify ways to develop community-level projects to augment TB and HIV control efforts. 


To date, there has been very little education or social mobilization concerning TB/HIV coinfection. While a large and growing network of HIV advocates and service organizations have mobilized around AIDS, TB has no comparable grassroots infrastructure, and has not hitherto been a focus of most HIV groups. 

Planning

TAG's TB/HIV Coinfection Education and Community Mobilization Workshop was conceived as the first step of a broader HIV and TB community mobilization effort to take advantage of a unique historical moment in the course of the two epidemics. TAG began planning the workshop in the spring of 2002, envisioning it as an opportunity to bring together people working in communities in countries struggling with severe TB and HIV epidemics. The objectives of the workshop were:

  • To educate patient community representatives on the various aspects of TB/HIV coinfection research, prevention, care and treatment.  
  • To empower patient community representatives to mobilize and disseminate information to their local communities.
  • To give patient community representatives the skills necessary to understand clinical trials and provide community input into research and operational programs. 
  • To begin the creation of an ad hoc international TB/HIV community advisory board to assist the WHO STOP TB TB/HIV Working Group and its Advocacy and Communications Working
  • To introduce patient community representatives to country NTP program officers, WHO, CDC, and NIH officials and regional officers so that they may work together to implement future TB/HIV initiatives. 


TAG assembled a broad-based Steering Committee (see attached list of members) that met in June 2002 just before the 4th World TB Congress in Washington, D.C. The steering committee worked with TAG to map out a plan for the workshop, to be held as a satellite of the 33rd IUATLD conference in October 2002. The Steering Committee continued to advise TAG throughout the processes of publicizing the workshop, requesting applications from potential participants, selecting participants, developing a program for the workshop, and identifying speakers. TAG provided funds for travel and accommodations to workshop participants from the developing world — principally from sub-Saharan Africa, but also representing Brazil, eastern Europe and India.

Participants

Twenty-nine people attended the workshop, including participants, presenters and moderators. Participants were selected based on representation of patient groups, experience in community work, and disease burden in country of origin. Interest in the meeting was considerable, and fewer than 25% of applicants were chosen to attend. Unfortunately, some invited participants were unable to attend due to health problems or last-minute visa difficulties. The workshop was also attended by participants from Canadian groups, including the Canadian HIV/AIDS Legal Network and the Montreal Public Health Department, and a Norwegian patient group working with organizations in the developing world (Norwegian Heart and Lung Association). Speakers included representatives from AIDS community groups in Brazil, southern Africa, Europe and the U.S.A., along with the U.S. Centers for Disease Control and Prevention (CDC), and the Stop TB program of the World Health Organization (WHO). Following the workshop, participants attended the Stop TB DOTS Expansion Working Group meeting and the 33rd IUATLD conference following the workshop, and met with TB control program representatives from their countries and regions. 

Workshop Presentations & Discussions

Tuberculosis & HIV Co-infection
—Dr. Kenneth Castro, Division of Tuberculosis Elimination, CDC, Atlanta, GA, USA

Dr. Castro began the morning presentations with an overview of TB in the context of HIV infection. He began by noting the interactions between TB and HIV:

  •  TB enhances/accelerates
    • replication of HIV
    • HIV disease progression
       
  • HIV increases
    • risk of active TB
    • mortality after TB treatment 
    • resistance to TB drugs
       
  • Treatment for either improves the outcome for the other.


Dr. Castro reviewed data indicating that TB is a leading cause of HIV-related mortality, and that the HIV epidemic in high prevalence countries is driving higher TB incidence and death. He outlined the World Health Organization's DOTS model (Directly-Observed Therapy, Short-course) for TB control:

  • Government commitment to TB control
  • Microscopy-based passive case-finding
  • Standardized short-course chemotherapy under Directly-Observed Treatment
  • Secure supply of quality drugs
  • Case registry, monitoring, and evaluation


Dr. Castro discussed the course of TB disease, including clinical manifestations more common in people co-infected with HIV, such as extrapulmonary disease, possibly paucibacillary pulmonary TB, and atypical chest radiographs with fewer cavitary lesions. He noted that HIV has been associated with higher frequencies of multi-drug resistant TB (MDR-TB). Using case reports, Dr. Castro discussed treatment challenges in people with HIV (PWHIV) who have active TB disease. While relapse rates are low among coinfected people treated for TB under DOTS, early mortality is high – sometimes due to late diagnosis of TB or to other AIDS-related comorbidities. Among people with TB disease, highly active antiretroviral therapy (HAART) may sometimes induce paradoxical reactions in people with TB infection, which include a temporary worsening of symptoms and lesions. In addition, many anti-HIV medications interact with rifamycin drugs (rifampin and rifabutin) used to treat TB, reducing their efficacy or increasing their toxicity.

Dr. Castro reviewed the recommended medical evaluation for people with HIV suspected of having TB, and outlined treatment options, including recommendations for pregnant women, children and patients with extrapulmonary TB. He discussed options and indications for treatment of latent TB infection in PWHIV and addressed clinical management of paradoxical reactions.

Dr. Castro outlined lessons from TB control for HIV strategies:

  • Cure … Victory
  • Treatment = Prevention
  • Access to essential drugs is crucial
  • Adherence is key
  • Drug resistance must be prevented

He concluded by offering some current questions requiring attention and research:

  • What are the best methods to rule out active TB when considering isoniazid preventive therapy (IPT)? 
  • What is the best short course regimen for preventive therapy? What options are available where lab capacity for drug susceptibility testing is limited? 
  • How can we improve on mechanisms ensuring an adequate drug supply, proper surveillance, and program coordination?

Discussion following Dr. Castro's presentation focused on TB exposure risks to HIV infected or uninfected health care workers treating people with HIV in high TB burden settings; patient and health care provider education; identifying and managing paradoxical reactions; the use and availability of IPT; the role of sputum samples and chest x-rays in TB diagnosis and the diagnosis of extrapulmonary TB (ETB); and the relation of MDR-TB to HIV infection.

The History, Natural History, & Treatment of HIV Infection
—Mark Harrington, Treatment Action Group (TAG), New York, NY, USA 

Mark Harrington provided background on the epidemiology and course of HIV disease and the impact of antiretroviral treatment on natural history. He reviewed data on the origins and spread of HIV, and outlined the natural history of AIDS from transmission to primary infection, chronic infection, progressive infection and AIDS. He discussed common opportunistic infections (OIs) and the evolution of HIV treatment in the United States from the era of OI prophylaxis and antiretroviral monotherapy through to the discovery and validation of HAART and the development of current US and WHO guidelines for use of ART in developed and resource poor settings, respectively.

WHO recommendations for initiating therapy in adults & adolescents with HIV infection:

  • If CD4 testing available:
    • WHO stage IV disease [clinical AIDS] irrespective of CD4 cell count
    • WHO stage I, II or III with CD4 cell counts below 200/mm3
  • If CD4 testing unavailable:
    • WHO stage IV disease irrespective of total lymphocyte count [TLC]
    • WHO stage II or III disease with a TLC below 1200/mm3

–Scaling Up Antiretroviral Therapy in Resource-Limited Settings: Guidelines for a Public Health Approach, WHO, April 2002—Table A, p. 12 

Mr. Harrington noted the benefits and limitations of current HAART regimens, including reduction of AIDS infections and prolongation of life, difficulties with adherence, resistance and toxicity, high pill burden, impact on quality of life, and cost. He reviewed the April 2002 WHO guidelines for use of antiretrovirals in people with active TB disease.

Antiretroviral therapy for individuals with tuberculosis co-infection

 

Situation

Recommendations

Pulmonary TB [PTB] and CD4 count <50/mm3 or extrapulmonary TB
 

Start TB therapy. Start one of these ARTs as soon as TB therapy is tolerated:

AZT/3TC/ABC

AZT/3TC/EFZ

AZT/3TC/SQVr

AZT/3TC/NVP

PTB and CD4 50-200/mm3 or TLC below 1200/mm3

Start TB therapy. Start one of these regimens after completing 2 months of TB therapy:

[Same four regimens

PTB and CD4 >200/mm3 or TLC > 1200/mm3

Treat TB. Monitor CD4 counts is available. Start ART according to HIV symptoms, CD$ or TLC as in table A [adults] or B [children]

AZT = azidothymidine (zidovudine), 3TC = lamivudine, ABC = abacavir, EFZ = efavirenz, SQVr = saquinavir + low-dose
ritonavir, NVP = nevirapine.

 

—Scaling Up Antiretroviral Therapy in Resource-Limited Settings: Guidelines for a Public Health Approach, WHO, April 2002 - Table G, p. 21

Mr. Harrington reviewed recent studies indicating that HAART reduces the risk of TB disease by 80%, and provided a brief history of global treatment access activism and its impact on prices for antiretroviral therapy. He concluded by pointing to future directions in TB/HIV policy and laid out some urgent research priorities.

  • Integrate TB & HIV programs.
  • Earlier case detection and treatment of TB in HIV infected persons.
  • Study use of HAART in HIV infected persons with TB disease
  • When to treat TB in HIV? Treat TB first, or treat TB/HIV together? 
  • Which regimens are best in coinfection?
  • Use of directly observed therapy (DOT) for HAART?
  • Develop more potent, less toxic, faster acting anti-TB drugs and regimens.
  • Develop faster, cheaper point-of-use tests for diagnosis of TB in HIV+ people.
  • Develop faster, cheaper tests for detection of drug-resistant TB strains. 
  • Develop better TB vaccines.


Discussion following Mr. Harrington's presentation focused on diagnosis and management of side effects of HAART, the role of education and support in adherence to HAART regimens, the prospects for expanding mother-to-child-transmission prevention (MTCTP) programs to incorporate on-going treatment for families (MTCT-Plus), and guidelines for HAART use in children with HIV.

A Framework for Access to TB/HIV Prevention and Care

- Dr. Dermot Maher, Stop TB Department, World Health Organization, Geneva, Switzerland

Dr. Dermot Maher concluded the morning presentations with a description of WHO's "Strategic Framework to Decrease the Burden of TB/HIV". Noting that at least one in three people with HIV will develop active TB disease, Dr. Maher reviewed available interventions against TB and HIV and identified points in the course of the diseases which provide opportunity for a unified health sector strategy. Dr. Maher discussed an "expanded scope of new strategy to control TB in high HIV prevalence populations". 

  1. Intensified TB case-finding and treatment
     
  2. Additional measures beyond TB case-finding and treatment
  • –TB preventive therapy
  • –Interventions to decrease morbidity and mortality in HIV-infected TB patients
  • –Interventions to decrease HIV transmission
  • –ARV therapy  


He assessed the current state of implementation of available interventions, noting that existing condom distribution efforts were inadequate for HIV prevention, only 30,000 PWHIV in Africa were receiving HAART, and the majority of countries with HIV prevalence rates greater than 5% had not achieved WHO's target of 85% cure rates for TB. Finally, he suggested models for TB and HIV control program collaboration, including joint activities involving planning, surveillance, staff training, drug supply chain management and related logistics, and case detection and management. Dr. Maher noted recent increases in aid to global diseases of poverty and in research on implementation, concluding that a combination of commitment, resources, and action will produce results.

Community Mobilization Panel Discussion
–Farai Mugweni, Southern African Network of AIDS Service Organizations (SANASO), Harare, Zimbabwe
–Rob Camp, European AIDS Treatment Group (EATG), Barcelona, Spain
–Ezio Santos-Filho, Grupo Pela VIDDA, Rio de Janeiro, Brazil

Farai Mugweni began the panel discussion with a description of the mission and structure of SANASO, noting that the network includes over 1000 organizations in the Southern African region. Organizations represent groups working on prevention, voluntary counseling and testing, home-based care, orphan support, operational research, skills training, and advocacy. SANASO works to develop networks at country level, coordinate communication and information sharing, and spur political commitment. 

Rob Camp discussed the experience of the EATG in conducting treatment education training meetings with international patient and consumer groups. He noted the role of the European Consumer Advisory Board (ECAB) in meeting with pharmaceutical companies and academic researchers, and in providing input into research and trial design, expanded access, drug pricing, and implementation of treatment guidelines.

Ezio Santos-Filho described Brazil's experience with implementing antiretroviral therapy, noting that from the perspective of community advocacy, Brazil has been a victim of its own success. Widespread availability of HAART has led to a "social demobilization" similar to that seen in earlier decades around tuberculosis, presenting new challenges in addressing persistent gaps in quality of and access to treatment.

Following the panel discussion, workshop participants divided into four groups, moderated by Ms. Mugweni, Mr. Camp and Mr. Santos-Filho, David Barr, and Winstone Zulu. Group discussion focused on questions around strengthening and coordinating TB and HIV care and services on local, country, and regional levels. Groups raised a number of issues and suggestions:

  • Utilize World TB Day to raise awareness.
  • Lobby local political and community leaders, and work with doctors and nurses.  
  • Link TB with HIV educational activities.
  • Increase the awareness of and perception of TB risk among people with HIV.  
  • Organize country-level meetings of all TB and HIV stakeholders.  
  • Strengthen the health care system through training, human resources and drug procurement.
  • Conduct operational research on program coordination.
  • Develop training for educators and health care providers.  
  • Address HIV- and TB-related stigma and delays in seeking treatment. 
  • Focus on political will and resources, and address issues of good governance and accountability and transparency.
  • Exploit existing TB infrastructures for drug procurement and supply management to build out antiretroviral access. 
  • Involve NGOs in applications to the Global Fund to Fight AIDS, TB and Malaria.
  • Use regional HIV meetings and conferences as further opportunities to discuss the links between TB and HIV.
  • Develop programs and strategies to work with drug injectors and prisoners. 


Community Mobilization Overview
–Kraig Klaudt, Massive Effort, Geneva, Switzerland 

Kraig Klaudt concluded the workshop by presenting a model for planning community mobilization campaigns around TB and HIV. He stated that community mobilization efforts can have two goals and two audiences.

  1. Changing social/political behavior by creating a cause—policy-makers and donors 
  2. Changing risk group behavior by focusing on people—individuals and at risk or affected communities


Mr. Klaudt outlined approaches to developing community mobilization strategies, citing historical examples as well as several examples from TB and HIV. He proposed a four part process.

  1. Documentation: Identify and research a problem, providing data and statistics. 
  2. Agenda setting: Create and market a solution to respond to the problem.  
  3. Coordination: Bring in partners and provide measurable targets and outcomes. 
  4. Social mobilization: Expand the focus to community-level work and foster global advocacy.


Mr. Klaudt noted that WHO views social mobilization as an essential part of achieving success in realizing the WHO targets for TB case detection and cure rates under DOTS. He described initial steps taken by WHO and others to address community mobilization, and cited the historic opportunity of linking TB mobilization with existing successful and ongoing community mobilization efforts around HIV. He identified several components of successful social mobilization efforts, including offering activities accessible to the public, creating iconic symbols—such as the red ribbon for AIDS awareness—and identifying measurable targets for desired results. He emphasized the critical role of the media, citing data suggesting that in the United States, AIDS funding and TB funding have each followed patterns corresponding to the amount of newspaper, radio, and television coverage these diseases have received. Following the presentation, participants discussed ideas and examples for adapting these models to TB/HIV mobilization activities.

3rd DOTS Expansion Working Group & 33rd IUATLD Conference 

Following the workshop, participants attended the 3rd DOTS Expansion Working Group public meeting on October 6, and the 33rd International Union Against Tuberculosis and Lung Disease (IUATLD) conference from October 7-9. The conference featured several sessions on TB/HIV coinfection. In addition, workshop participants met with various officials, including national TB program coordinators, and with Dr. Richard Feachem, executive director of the Global Fund to Fight AIDS, TB and Malaria. Participants also met as a group throughout the conference to discuss presentations they attended, identify key areas of concern and talk about plans for using the information and discussions from the workshop in follow-up activities back home.

Follow-Up Ideas, Activities & Plans

Workshop participants reconvened for a final meeting to discuss follow-up activities. A number of suggestions and strategies were proposed.

  • Organize similar workshops on a regional level; the 13th International Conference of HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) in Nairobi, Kenya in September 2002 was proposed as an ideal setting.
  • Develop a training of trainers at country level to disseminate information on TB/HIV coinfection.
  • Adapt educational materials to local languages and cultures.
  • Integrate TB into HIV education.
  • Use existing educational groups to mobilize community members around TB advocacy issues (early diagnosis, INH prophylaxis, reducing stigma, etc.).
  • Meet with NTP and NACP program managers to discuss program coordination. 
  • Advocate for joint TB/HIV strategies within Country Coordinating Mechanisms (CCMs).


Workshop participants will stay in contact through an email list designed to encourage information sharing and the discussion of strategies. TAG will track the on-going activities of workshop participants and provide support and feedback on advocacy efforts.

Evaluation & Results 

Workshop participants completed a brief written evaluation addressing the following questions:

  • What did you learn during the workshop?
  • Besides information, what else did you get out of participating?
  • How will you use this knowledge and experience in your work?
  • How could we improve the workshop?

Participants overwhelmingly called the workshop a success, felt the format and content were useful and appropriate, and learned from every presentation. Participants also appreciated the opportunities for group discussion and the chance to network with each other and with other IUATLD attendees from their countries and regions. 

There was a strong desire among participants for a follow-up meeting or workshop. Participants also recommended that future workshops attached to conferences should work with conference organizers to include a speaker or session on social mobilization. Suggestions for future versions of the workshop focused on the possibility of doing longer workshops with added discussion time and training exercises.

Ongoing & Planned In Country Follow-Up Activities

Within a month after the workshop, participants have reported the following activities and plans:

  • Botswana—Pedzisani Motlhabane from BONASO is working with a network of ASOs to develop a community mobilization plan on TB/HIV coinfection, and discussed TB/HIV at an October 2002 NGO meeting.  
  • Brazil—Ezio Santos-Filho from Grupo Pela VIDDA and the TB Control Program/RJ-MSH is planning a regional TB/HIV meeting in 2003 in conjunction with the Rio de Janeiro TB control program and the IUATLD.
  • Estonia/Eastern Europe—Andrej Kastelic from IHRD is working on incorporating TB into HIV trainings and meetings around the region.
  • Kenya—Ludfine Opudo from SWAK is developing a proposal for community mobilization around early TB diagnosis and treatment. Dorothy Onyango from WOFAK is working on working on planning a TB/HIV component for the 13th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) in Nairobi in September 2003.
  • India—Manoj Pardesi from the Network of Maharashtra PLWHAs is working with his network on promoting TB screening for HIV infected individuals, disseminating information to community members on TB/HIV coinfection and identifying needs for IEC materials, including translation of existing information. 
  • Malawi—Leopold Buhendwa from MSF-L/Thyolo is developing a plan for INH and cotrimoxazole prophylaxis through a home based care program; planning to integrate TB and HIV care (including HAART) at the district level; creating an action plan for a coordinated country-level response to TB/HIV and consulting with other TB and HIV clinicians and researchers.  
  • Zambia—Winstone Zulu, Kara Counseling & Training Trust will be holding a TB/HIV concert event attended by 400 students at a teachers college; initiating weekly outreach activities on TB/HIV coinfection; planning a four-day workshop to train outreach workers on TB/HIV coinfection. Amos Nota from ZAMBART is working on incorporating TB/HIV health education into a research project on delays in TB diagnosis and initiation of treatment.


Summary & Conclusions

The workshop was very successful at bringing together patient community representatives, providing a solid foundation of TB/HIV knowledge, fostering discussion and networking, and promoting post-workshop education and social mobilization activities. The workshop also provided some valuable lessons for the future.  

There is a strong appetite for knowledge and discussion around TB/HIV among people from communities facing serious coinfection epidemics.

The Montreal workshop succeeded in bringing together local community leaders from the developing world who were ready and able to use the workshop and conference experience to expand their activities in their countries and begin to develop country, regional, and global networks addressing TB/HIV coinfection.

We were not able to bring everyone we invited due to visa and health problems, issues that will require consideration for future workshop planning.

There is a strong desire and need for future meetings and regional workshop.

Participants indicated a need to identify funding sources to support their follow-up education and community mobilization activities.

TB/HIV Coinfection Education & Community Mobilization Workshop

Centre St-Pierre Apôtre—1212 rue Panet
Montreal, Québec, Canada

Workshop Agenda 

5 October 2002
Introductions & workshop overview
TB/HIV overview
TB/HIV epidemiology, natural history, prevention & treatment—Kenneth Castro, CDC
HIV natural history & treatment—Mark Harrington, TAG
Access to care & program models—DOTS, ProTEST, etc.—Dermot Maher, STB, WHO
Community mobilization panel discussion
SANASO, Southern Africa—Farai Mugweni
Grupo Pela VIDDA, Brazil—Ezio Santos Filho 

EATG Southern/Eastern States—Rob Camp
Strategies for Community Mobilization (Small Group Discussions and Report Back)
Community Mobilization Overview—Kraig Klaudt, Massive Effort
Wrap-up & plan for conference activities
Conference Activities

6 October 2002
3rd DOTS Expansion Working Group public meeting

7-9 October 2002
33rd International Union Against Tuberculosis & Lung Diseases (IUATLD) conference

TAG TB/HIV Coinfection Education & Community Mobilization Workshop
Participant List

David Barr*, AIDS Treatment Activist Coalition (ATAC), USA
Leopold Buhendwa, Médecins sans FrontiPres-Luxembourg (MSF-L)/Thyolo, Malawi
Rob Camp*, European AIDS Treatment Group (EATG), Spain
Kenneth Castro*, Centers for Disease Control and Prevention (CDC), USA
Dagmar Forland, Norwegian Heart & Lung Association, Norway
Marie-Claude Fournier, Direction de la santé-publique, Canada
Patrick Gomani, Médecins sans FrontiPres-Luxembourg (MSF-L), Malawi
Mark Harrington*, Treatment Action Group (TAG), USA
Olav Kasland, Norwegian Heart & Lung Association, Norway
Andrej Kastelic, International Harm Reduction Development—Open Society Institute, Slovenia
Kraig Klaudt*, Massive Effort, Switzerland
Dermot Maher*, STOP TB, World Health Organization (WHO), Switzerland
James Mafusire, Botswana Network of PLWHAs (BONEPWA), Botswana
Pedzisani Motlhabane, Botswana Network of ASOs (BONASO), Botswana
Farai Mugweni*, Southern African Network of ASOs (SANASO), Zimbabwe
Ketty Mfune Mumba, Lusaka Home Based Care, Zambia
Amos Nota, Zambia AIDS Related TB Project, Zambia
Leonora Omala, INTERSOS, Kenya
Dorothy Onyango, Women Fighting AIDS in Kenya (WOFAK), Kenya
Ludfine Opudo, Society of Women Against AIDS—Kenya (SWAK), Kenya
Manoj Pardesi, Network of Maharashtra PLWHAs, India
Daniel Raymond*, TAG, USA—Workshop Coordinator
Kirsten Rrhme, Norwegian Heart & Lung Association, Norway
Ezio Santos-Filho*, Grupo Pela VIDDA-Rio de Janeiro/TB Control Program/RJ-MSH, Brazil
Gaseone Serite, Botswana Network of PLWHAs (BONEPWA), Botswana
Peter Small, Gates Foundation, USA
David Thompson, Canadian HIV/AIDS Legal Network, Canada
Svain Wasshaug, Norwegian Heart & Lung Association, Norway
Winstone Zulu*, Network of PWHIV, Zambia

* Denotes presenter/moderator 

TB/HIV Education & Community Mobilization Workshop
Steering Committee

Nils Billo, M.D., IUATLD
Joanne Carter, Results
Kenneth Castro, M.D., CDC
Ben Cheng, Forum for Collaborative HIV Research
David Cohn, M.D., UCHSC & Denver DOH
Fred Gordin, M.D., VA Medical Center, Washington, D.C.
Robert Eisinger, Ph.D., Office of AIDS Research, NIH
Mark Harrington, TAG
Petra Heitkampp, STOP TB, WHO
Alan Hinman, M.D., The Task Force for Child Survival and Development
Vivien Jackson, World Bank
Barbara Laughon, Ph.D., Division of AIDS, NIAID, NIH
Dermot Maher, M.D., STOP TB, WHO
Michael Marco, Social & Scientific Systems
Bess Miller, M.D., CDC
Scott McCoy, CDC
Ferai Mugweni, SANASO, Zimbabwe
William Pick, J.D., USAID
Daniel Raymond, TAG—Workshop Coordinator
Lee Reichman, M.D., UMDNJ—Medical Faculty Leader
Joëlle Tanguy, Global Alliance for TB Drug Development