This toolkit has been developed to assist facility level administrators and health care workers in communities with a high prevalence of both TB and HIV to implement TB infection prevention and control measures, using the “Three I’s” framework as articulated by the World Health Organization. The toolkit provides step-by-step guidance on strengthening TB infection control practices at the facility, intensifying case finding among HIV-infected patients, and incorporating isoniazid preventive therapy into the care and treatment provided to persons living with HIV.
Overview of TB Prevention among PLHIV: Just as the recent global rise in tuberculosis incidence has been fueled by the global HIV epidemic, so too is TB control linked inextricably to the care and treatment of persons living with HIV. This section of the toolkit provides background information regarding the Three I’s approach to reducing TB transmission in health care facilities, detecting TB disease early in its course, and preventing future TB disease in PLHIV.
Implementing TB Prevention: This section of the toolkit provides step-by-step guidance on implementing the three key strategies of TB prevention (the Three I’s) at the facility level: TBIC, ICF, and IPT. In order to effectively implement these strategies, facility based staff members must understand the action steps required and how their success will be evaluated. They should also have training to competently implement these measures. For each of the Three I’s, we have included sub-sections on action steps, monitoring and evaluation, and training tools.
Implementing Continuous Quality Improvement of TB Prevention Activities: TB prevention involves a multifaceted set of activities with many “moving parts.” Optimal implementation of these activities requires continuous evaluation of their impact and fine tuning of programs in order to best address site-specific needs. This section provides guidance on how to identify the continuous quality improvement activities that will have the greatest impact on TB prevention. Examples of CQI activities from the field are also included, along with websites that provide additional instruction.