Tackling the HIV-TB co-infection

Josephine Chinele, CNS Correspondent, Malawi
Last week global health professionals, TB and HIV specialists, researchers, civil society members and communities affected by TB and/or HIV deliberated at TB 2016 (followed by AIDS 2016) in Durban, South Africa. These two conferences were convened by the International AIDS Society (IAS).

A joint statement from José Luis Castro, Executive Director, The International Union Against TB and Lung Disease (The Union) and Owen Ryan, Executive Director, IAS said that the two diseases together make up a co-epidemic, posing unique challenges to individuals and communities that bear the burden of both diseases at the same time. It emphasised that, “TB and HIV are deeply intertwined, particularly in sub-Saharan Africa. TB has become the leading cause of death among those who are HIV-positive, despite the fact that today HIV infection can be managed with antiretroviral medication, and TB can be cured in the vast majority of cases. Since HIV infection weakens the immune system, a person living with HIV is 26 to 31 times more likely to develop active TB than someone who is HIV-negative. Of the 1.2 million people who died from AIDS-related illnesses in 2014, one in three deaths resulted from TB-HIV co-infection. At the same time, 25%of all TB deaths were HIV-associated”.

“It is essential that we address the TB-HIV co-epidemic at every opportunity. We know what to do; the World Health Organization (WHO) first endorsed a policy approach for jointly addressing TB-HIV in 2004. Since 2005, WHO estimates that 5.8 million lives have been saved by interventions that have jointly addressed TB and HIV. Yet, in 2014, only half of TB patients worldwide had a documented HIV test result—the first step in initiating treatment and care for TB-HIV co-infection. We must advocate better. We must collaborate across TB and HIV communities better - because, in fact, the communities affected by TB and HIV are very often the same”, read the statement.  

Dr James Mpunga, Director of the National TB Control Programme, Malawi, admits that TB and HIV co infection is still a public health concern, despite the fact that Malawi has made strides in this area. He informed that the proportion of TB/HIV co-infected people initiated on ART has increased from 81% in 2012 to 88% in 2013 and the proportion of people co-infected with TB and HIV has decreased from 77% in 2000 to 57% in 2013. However the proportion of TB patients who unfortunately die while on treatment is 7% for smear positive TB cases.

Information from a TB prevalence survey, that the organization did in 2014, indicates that half of the people who are sick with TB may still be missing as there are many TB patients in the community who are not detected and treated. Close to 19,000 TB cases were reported in 2013. “We cannot win the fight against HIV/AIDS without also tackling TB,” said Linda-Gail Bekker, IAS President-Elect. “Too often, TB and HIV team up against us, but with this conference we are supporting a global movement to bring the TB and HIV responses together to defeat both epidemics. TB 2016 reminds us that the work before us will take place not only in laboratories, but also in the halls of governments, in health facilities, and in the communities affected by these two devastating epidemics.”

The Union statement highlights that it is essential that the global health should address the TB-HIV co-epidemic at every opportunity. One of the targets of goal 3 of the Sustainable Development Goals (SDGs) aims to end by 2030 the epidemics of  AIDS, TB, Malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. The WHO stresses that TB continues to pose a significant challenge to the HIV response. Even in the era of ART scale up, TB is still the main cause of hospitalization and deaths among PLHIV. It further highlights that bold targets for HIV are included in the Fast Track Strategy to end the HIV epidemic by 2030 and implicit in these targets is the urgent need to address HIV associated TB.

Josephine Chinele, Citizen News Service - CNS
26 July 2016

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