Lung health beyond 2015: Can we win the war against TB-HIV co infection?

Diana Esther Wangari, CNS Correspondent, Kenya
(First published in The Star, on August 26, 2015)
Photo credit: CNS
 A few months ago, I remember watching a world marathon where one of the top runners got a muscle cramp and he suddenly stopped for a fraction of a second, only to continue on at a much slower pace. If you have watched any marathon or a race before, you will know how a lapse of millisecond often makes a large difference. Naturally, the runner fell behind and as he hopped on - in what must have been obvious pain judging from his facial expression - I began wondering what kept him going? After all, there was no chance of him crossing the finish line first and at that pace, it would certainly be a miracle if he made it among the top five.

He did not. But he did make it to the finish line...eventually. In a later interview as he explained what kept him going, there was one response that caught my eye, "I kept on thinking of the finish line and with that target in mind, I pushed on." In many ways, for the Millennium Development Goals (MDGs), the year 2015 symbolically was the finish line as they were the world's time bound and quantified targets. The year is fast drawing to a close and while some of the goals have been achieved or even surpassed, others remain battles that are yet to be won. It has been like running a marathon, replete with hurdles, but we have pushed on especially as we had targets in mind.

Therefore one does wonder, what happens beyond 2015?

We might be tempted to consider it a formidable task, particularly for those goals that seemingly are far from being met. Or else, patting our backs for the targets achieved, we might slacken in the illusion that a battle won is a war conquered.

One such continuing battle is against TB and HIV, where great strides have been made, but we are still far away from the finish line. Yet one needs to compare the state of TB-HIV co- infection in patients in the early 90s (when we were still trying to figure it all out) with the current status where TB-HIV collaboration activities have been firmly established by the Stop TB strategy formulated by the WHO in 2006.

In which case, the question is: Is it possible to sustain and enhance these achievements beyond 2015?

Dr. Riitta Dlodlo, Director of the Department of TB and HIV at the International Union Against Tuberculosis and Lung Disease (The Union), pondered on this same question and discussed various measures that could be implemented or reinforced as it were to aid in the quest for sustainability.

Continuation of anti retroviral therapy (ART) was one such factor--patient cohorts must be monitored as the medications are taken for a lifetime. Therefore, regardless of when one began taking the drugs-- five years ago or a week ago-- it is important to keep track of the increasing patient population. This makes a lot of sense, as treatment adherence is essential.

In addition, quality care plays a key role in the hope that through testing and treatment we will be able to reduce TB co-infection in people living with HIV.  Dr Dlodlo explained, "The measure of quality care from a medical point of view is the viral load which should be undetectable. That shows that their degree of infectiousness is minimal or as close to zero as it can be and that the anti-retroviral (ARV) drugs are working. In addition, viral load can be used to indicate treatment failure and hence the need to adjust the ARVs accordingly."This indeed makes a lot of sense.

She cited the example of Zimbabwe, her own country of work, where in spite of the national challenges, they have admirably been able to accelerate those components of TB-HIV collaborative activities that aim to reduce TB burden among HIV patients. The figures are quite impressive-- Provider Initiated Counselling and Testing (PITC) coverage is 95%- 97%, and that means most TB patients were aware of their HIV status simply after visiting a health facility. But even more impressive is the ART coverage, which increased dramatically from 44% in 2010 to 81% in 2013.

Dr Dlodlo reiterated her belief that if Zimbabwe, despite challenges faced over the past few years, can make it then we all can.Therefore, a message of hope resonates beyond 2015 and if you are still wondering if it is possible to sustain and improve upon our past achievements post 2015, then the answer is YES, it is possible. 

Diana Esther Wangari, Citizen News Service - CNS
August 31, 2015

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