Six I's HIV/TB Communication and Advocacy Toolkit

This toolkit, developed by the AIDS and Rights Alliance for Southern Africa (ARASA) and partner organisations from across the Southern African region, was designed to be an accessible and scientifically accurate training and advocacy material to promote the accelerated implementation of the Six I’s for HIV/TB (tuberculosis), which are based on the World Health Organization’s (WHO) recommended interventions to reduce TB morbidity and mortality in people living with HIV.

As explained in the toolkit, “According to the World Health Organisation (WHO), it is estimated that one-third of the 36.7 million people living with HIV and AIDS worldwide are co-infected with tuberculosis (TB). Sub-Saharan Africa is the hardest hit region, with a 70% co-infection rate. If TB is left unaddressed, in the next 20 years almost one billion people will become newly infected, and 35 million will die of it. In response to this concern, the WHO has issued a policy on TB/HIV collaborative activities recommending interventions to reduce TB morbidity and mortality in people living with HIV, namely the Six I’s for HIV/TB: Infection Control, Intensified Case Finding and Isoniazid Preventive Therapy, TB/HIV Integration, Initiating ARV treatment and Involvement of the Community; which should be integrated into HIV programmes of national health services in addition to the provision of Antiretroviral Therapy (ART).”

The toolkit development process was shaped by the collective participation of TB/HIV community activists, health workers, journalists, traditional healers, government representatives, and WHO/TB technical and medical experts, from seven different Southern African countries. The development of the toolkit was based on an understanding of the obstacles and opportunities facing the implementation of the Six I’s for HIV/TB in the region and therefore seeks to address these. ARASA will work with country partners to support the use of the toolkit in community settings and with national HIV and TB programmes.

The toolkit has a superhero-theme and each of the 6 I’s is represented by a superhero: Intensified Case Finding (ICF), Isoniazid Preventative Therapy (IPT), Infection Control (IC), Initiation, Nurse X (for TB/HIV Integration), and Nurse Community (for involvement of the community). They introduce each of the relevant sections in the toolkit and outline their role in addressing HIV and TB.

The toolkit includes the following:

1. Frequently Asked Questions on the Six I’s for HIV/TB for health workers and communities
2. Glossary to define commonly used terms
3. Congregate settings examples to highlight the impact of HIV/TB in settings outside of health care facilities
4. Posters to promote the adoption of the Six I’s for HIV/TB to be used both by health care facilities and communities
5.  Checklists for patients and communities as well as health care workers to assess the safety of health facilities and the availability of essential HIV/TB services therein;
6. WHO recommendations on the Six I’s for HIV/TB
7. Presentation on the Six I’s for HIV/TB to developments in scientific research for HIV/TB
8. Best practices of HIV/TB related activities in the region

It is divided into the following sections, which include a section on each of the Six I’s:

• Introduction
• Acknowledgements
• Glossary
• Meet people in your community
• Background on TB and TB/HIV
• Intensified case finding (ICF)
• Isoniazid preventive therapy (IPT)
• TB infection control (IC)
• Initiating antiretroviral treatment
• TB/HIV integration
• Involvement of the community
• Statistics
• TB IC for Patients Checklist
• TB IC checklist for health care facilities
• WHO Recommendations for TB Infections