In settings with a high HIV/TB burden and significant shortages of human resources for health (HRH), task shifting strategies have relied on lay workers to provide HIV testing and counselling (HTC) and adherence support for HIV and TB treatments. While in some countries these tasks were integrated into the work of existing community cadres such as community health workers, new basic cadres have been created and trained in other countries, supported mainly through international funds.
Agreements made with donors have mostly been to provide temporary support until a long-term solution was found.
Unfortunately, there are few examples where Ministries of Health have been able to absorb lay counsellors into their health system or otherwise sustain their work.