Table 6 Key messages from the evaluation report (extracted from reference 23) http://www.mrc.ac.za/healthsystems/operationalresearch2010.pdf

1. The study confirms the feasibility of integrating community-based care for clients living with TB and HIV. Evaluation of the health outcomes of integrated models that are implemented at scale, and outside of research settings, is needed to confirm the effectiveness of these approaches.

2. Providing support to co-infected clients using one LHW appears to be less intrusive and disruptive than having different LHWs support these clients, and is an important benefit of integrating community-based services.

3. Clients were very positive about their experiences of services rendered by LHWs. The majority of clients on directly observed treatment for TB would prefer self-administered treatment at home, however a notable proportion of these clients indicated a preference for LHW support during self-administration.

4. LHWs often become intimately involved in the psycho-social realities of clients and they noted that working with individuals with serious, and often stigmatised, diseases is emotionally stressful. It is therefore important that:

 a. LHW training include both the bio-medical aspects of TB and HIV and the psycho-social aspects of living with these diseases.

 b. ‘Caring for the Carer’ programmes be put in place to help LHWs manage these stresses.

5. Identifying clients at-risk of non-adherence and who need intensified LHW care and support, and using this information to prioritise LHWs’ work, is an effective way to manage the caseload of LHWs.

6. Establishing and maintaining high morale among LHWs is an important component of ensuring the delivery of quality services. Providing non-monetary incentives in recognition of their work is as important to LHWs as increased stipends.

7. The monitoring and evaluation tools used in the study sites strengthened the delivery of LHW services. These tools should be included in programmes that employ LHWs to provide treatment and adherence support to individuals living with TB and HIV.