Maher BMC Public Health 2010, 10:394 http://www.biomedcentral.com/1471-2458/10/394 Page 8 of 11 Table 5: Examples of programme activities where joint efforts for HIV and for tuberculosis epidemic control can be better integrated into a strengthened health system Programme activity Challenge Example of HIV and tuberculosis programme collaboration Joint contribution to development of standard measures for monitoring success of treatment, e.g. ART for HIV infection, learning from experience of standard outcomes in global tuberculosis control [44] Consequence for strengthened health system Better global documentation of overall rate of successful outcome of treatment of HIV/AIDS a priority disease of poverty Joint support of efforts to develop Improvements in coverage and national vital registration systems quality of vital registration systems would be of considerable benefit for better data on deaths of people with priority diseases of poverty, e.g. HIV and tuberculosis Programme monitoring and evaluation Programme monitoring and evaluation Infection control in health and other congregate facilities Raising community awareness of health-seeking behavior Risk behavior modification Treatment scale-up (first-line treatment regimens) Difficulty in measurement of the success of HIV treatment programmes because of highly heterogeneous monitoring systems and use of non- standardised definitions across programmes [46] Lack of a vital registration system in many of the countries most badly affected by HIV or tuberculosis (only five countries in Africa have vital registration systems covering more than 25% of the population) [57] Late presentation during disease progression of patients with HIV [11] and patients with tuberculosis [12] High continued levels of behaviour involving personal risk, e.g. unsafe sex [4] as a risk for HIV infection, and lack of cough hygiene as a risk for transmission of tuberculosis [27] Inadequate access to effective treatment of HIV infection [46] and tuberculosis [13] Lack of quantitative measure of Joint contribution to implementation of measures for development and HIV infection control and slow implementation of effective progress in implementing TB health system policies for infection control interventions [46] infection control in health and other congregate facilities Strengthened ability of health system to protect patients from nosocomial infection Better outcomes of treatment of patients presenting earlier in the course of disease, with health system efficiency savings Faster progress towards goal of universal access to key interventions for control of priority diseases of poverty Joint development and implementation of comprehensive communication measures aimed at raising community awareness of the importance of seeking health care earlier in the course of progression of priority diseases, e.g. HIV and tuberculosis Joint contribution to development and implementation of health system policies for decentralized provision of treatment of priority diseases, e.g. ART for HIV/AIDS, based on experiences of decentralised treatment of tuberculosis [52] Joint contribution to comprehensive health education aimed at promoting healthy behavior and decreasing risk of HIV and tuberculosis Improved health system approach to behavior modification regarding risk of HIV and tuberculosis among a wide range of diseases