introduction • criteria • funding available • selection process • how to apply • application

Introduction
Despite the fact that tuberculosis (TB) is preventable, treatable, and curable, TB is the most common co-infection and a leading killer of people with HIV. Historically, these two diseases have been approached by government health services as completely separate, with little attempt to coordinate services and care.

In 2004, the World Health Organization (WHO) called on countries to implement a set of collaborative TB/HIV program activities (Interim Policy for Collaborative TB/HIV Activities, (http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.330.pdf; see Appendix A) to establish mechanisms for collaboration, to decrease the burdens of TB among people with HIV/AIDS and to decrease the burden of HIV among TB patients. Moreover, with appropriate linkages, TB control programs are a potential gateway to antiretroviral therapy for at least 500,000 HIV-infected persons with TB per year (http://www.who.int/3by5/en).

Community-based advocacy, education and mobilization are key elements in expanding TB services to communities affected by HIV/AIDS and in establishing effective linkages between HIV and TB programs. OSI's TB/HIV Advocacy Grant Competition aims to promote a community oriented policy approach that utilizes these key elements to improve TB/HIV policies and programs in regions burdened by the dual epidemic.

Project Summary
The Open Society Institute (OSI) is calling for proposals to support projects aimed at improving local, national or regional policies and programs on TB/HIV co-infection. This TB/HIV advocacy small grants competition is intended to support TB/HIV advocacy work by organizations of people living with HIV/AIDS (PLWHA), HIV/AIDS treatment advocates and activist community groups and regional PLWHA networks in countries and regions affected by the dual TB/HIV epidemics.

The program focuses on AIDS groups—groups led or with major participation at all levels by people living with HIV/AIDS (PLWHA)—because such groups are the effective leaders of HIV/AIDS treatment literacy and treatment advocacy in most countries affected by the dual epidemics, and because integrating TB as a core concern of such groups is a critical element in improving TB policies, programs and services for people living with HIV/AIDS.

Projects proposing activities in one country can apply for up to $5,000. Projects from regional networks may apply for up to $15,000.

Purpose of Competition

• To fund the activities of community based groups and networks of People Living with HIV/AIDS (PLWHA) in countries with high or concentrated burdens of HIV and TB co-infection;
• Through these activities, to improve policies and programs (or implementation of existing policies and programs) related to TB/HIV co-infection and expand resources for joint or coordinated programming.

Activities Eligible for Funding

• Advocacy for adoption of joint TB/HIV policy guidelines at local, national or regional levels
• Advocacy for improved implementation of joint TB/HIV policy guidelines at local, national or regional levels
• Advocacy for better coordination of TB and HIV programs at local, national or regional levels
• Advocacy for increased resources devoted to TB and HIV programs in countries affected by both epidemics

The following types of activities WILL NOT be eligible for support:

• Research
• Direct lobbying
• Service delivery
• Purchase of drugs, diagnostic test kits, or medical equipment
• Programs for work in Western EU countries, the US, Canada, Australia, Japan, or New Zealand

  Criteria for Participation in Competition

• Grant application must come from existing community based organizations or regional networks.

Organizations must demonstrate:

• Capacity to implement advocacy work related to TB and/or HIV;
• Experience/focus on policy change;
• Adequate representation of PLWHA on board, staff and community levels; and
• Evidence of community based support and involvement.

Successful applications will address issues raised by the Advisory Committee for 2004's grant competition (see Appendix B).

  Funding available
Projects proposing activities in one country can apply for up to $5,000. Projects from regional networks may apply for up to $15,000.

Treatment Action Group Founded in January, 1992, the Treatment Action Group, or TAG, is the first and only AIDS organization dedicated to advocating for larger and more efficient research and treatment efforts, both public and private, towards finding a cure for AIDS. The Treatment Action Group (TAG) fights to find a cure for AIDS and to ensure that all people living with HIV receive the necessary treatment, care, and information they need to save their lives. TAG focuses on the AIDS research effort, both public and private, the drug development process, and health care delivery systems. We meet with researchers, pharmaceutical companies, and government officials to encourage exploration of understudied areas in AIDS research and speed up drug development, approval, and access. We work with the World Health Organization and community organizations globally, and strive to develop the scientific and political expertise needed to transform policy. TAG is committed to working for and with all communities affected by HIV. The TAG TB/HIV Project works to combat TB/HIV co-infection through a combination of community-based advocacy, education and mobilization efforts involving AIDS advocates in developed and developing countries TAG has sponsored three International TB/HIV Community Education & Mobilization Workshops, and works with OSI and partners around the world to improve TB/HIV programs for people living with HIV/AIDS. More information about TAG is available at www.treatmentactiongroup.org.

  How to Apply        

Interested organizations should submit the grant application described below. Completed applications must be received by OSI on 4 March 2005 no later than 5pm Eastern Standard Time (EST). Incomplete applications will not be considered.

Applications can be sent via mail, email or fax to:

Organizations are strongly encouraged to submit their applications in English. The advisory committee will consider applications submitted in French, Spanish and Russian to the extent possible. If you have any questions, please direct your inquiries to Eleonora Jimenez at ejimenez@sorosny.org.

  Selection process A grant selection advisory committee consisting of global and regional experts and TB/HIV advocates will review the grant applications and select a group of finalist for the OSI grant awards. Finalists will be notified in early May 2005.

  Application Instructions
This grant application consists of nine parts:

to application

• Appendix A – WHO recommended collaborative TB/HIV activities
• Appendix B – Issues Raised in Advisory Committee Review

  Appendix A

I. WHO recommended collaborative TB/HIV activities
This document focuses on collaborative activities that address the interface of the tuberculosis and the HIV/AIDS epidemics and that should be carried out as part of the health sector response to the intersecting tuberculosis and HIV epidemics (Table 1).

These collaborative activities will be more successful where national HIV/AIDS and tuberculosis control strategies are based on international guidelines and are effectively implemented. The recommended activities can be implemented by tuberculosis and HIV/AIDS programmes, nongovernmental organizations, community-based organizations or the private sector generally under the coordination of the national tuberculosis and HIV/AIDS programmes.

II. Thresholds for starting recommended collaborative TB/HIV activities
Unlike other HIV-related opportunistic infections, tuberculosis can occur at all levels of the immune status (measured by CD4 lymphocytes count) of people living with HIV/AIDS and substantially contributes to the overall burden of disease among this group. Therefore, countries in any HIV-epidemic state and with intersecting epidemics of tuberculosis and HIV should implement collaborative TB/HIV activities as indicated in Table 2. HIV prevalence among tuberculosis patients is the most sensitive and reliable indicator for the intersecting epidemic of tuberculosis and HIV in a country. In the absence of data on this, the national adult HIV prevalence rate can be used as an indicator for starting collaborative TB/HIV activities. The adult HIV prevalence data often exist at national level and can be used to classify the epidemic state of a country.

Table 2 Thresholds for countries to start recommended collaborative TB/HIV activities
Category	Criteria	Recommended collaborative TB/HIV activities
I.	Countries in which the national HIV prevalence rate is ≥ 1% or countries in which the national HIV prevalence among tuberculosis patients is ≥ 5%	A. Establish the mechanisms for collaboration A1. Set up a coordinating body for TB/HIV activities effective at all levels A2. Conduct surveillance among HIV patients of tuberculosis prevalence A3. Carry out joint TB/HIV planning A4. Conduct monitoring and evaluation B. Decrease the burden of tuberculosis in people living with HIV B1. Establish intensified tuberculosis case-finding B2.Introduce isoniazid preventive therapy B3. Ensure tuberculosis infection control in health care and congregate settings. C. Decrease the burden of HIV in people living with tuberculosis C1. Provide HIV testing and counseling C2. Introduce HIV prevention methods C3. Introduce co-trimazole preventive therapy C4. Ensure HIV/AIDS care and support C5. Introduce antiretroviral therapy
II.	Countries in which the national HIV prevalence rate is below 1% and in which there are administrative areas with an adult HIV prevalence rate of ≥ 1%	Administrative areas with greater than 1% HIV prevalence: implementation of all activities as in Category I countries in the administrative areas identified. Other parts of the country: implementation of activities as in Category III countries.
III.	Countries in which the national HIV prevalence rate is below 1% and in which there are no administrative areas with an adult HIV prevalence rate of ≥ 1%	A. Joint national TB/HIV planning to implement: A2. Conduct surveillance among HIV patients of tuberculosis prevalence B. To decrease the burden of tuberculosis in people living with HIV/AIDS [with focus on groups with high risk for HIV and tuberculosis risk, e.g. injecting drug users, sex workers, and those living in congregate settings B1. Establish intensified tuberculosis case-finding B2. Introduce isoniazid preventive therapy B3. Ensure tuberculosis infection control in health care and congregate settings.

However, this will result in underestimation of high HIV prevalence rates in groups at high risk for HIV and in certain administrative areas within a country, particularly in geographically large countries. Therefore, countries should consider the regional (within- country) variation in HIV prevalence rates in order to decide on the types of collaborative TB/HIV activities to implement. For efficient use of their resources, countries with low HIV prevalence should focus as a priority on groups at high risk for HIV and tuberculosis such as injecting drug users, sex workers and congregate settings (e.g. workers' hostels, prisons, police and military barracks).

  Appendix B - Issues Raised in Advisory Committee Review
The TB/HIV Advisory Committee felt the following issues were critical and needed emphasis in successful applications:

• Need for significant involvement of people living with HIV/AIDS at all levels in funded organizations.
• Need for realistic time-frame related to project goals.
• Need for evidence of community-based support and involvement in the project.
• Better-defined budgets in closer relation to clear outcomes and goals.
• Greater clarity in how the proposed project will lead to improved TB/HIV policies and programs.
• Clarity that the project focuses on advocacy & policy rather than service delivery.
• Clear evaluation and follow-up procedures.
• If applicants participated in the TAG TB/HIV Workshops, what follow-up activities have occurred since?