Saving lives from TB-HIV co-infection through integrated care

Josephine Chinele, CNS Correspondent, Malawi
Over 50% of people living with HIV (PLHIV) in Malawi develop TB at some point of time and 7% of TB patients die whilst on treatment. International Union against TB and Lung Disease Press Statement titled TB 2016 and AIDS 2016: Jointly Tackling the Co-epidemic released in July this year says that these 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.

This is deeply entangling, particularly in sub-Saharan African countries like Malawi, as 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 therapy (ART), and TB can be cured in the vast majority of cases. When a person develops HIV, the immune system loses its ability to fight off infections, making him/her more vulnerable to developing other diseases like TB. PLHIV are especially vulnerable to TB in countries where TB is common. Roughly 75% of PLHIV who contract TB live in sub-Saharan Africa. In some countries in this region, up to 80% of individuals with active TB disease are also HIV-positive. WHO acknowledges that though steps have been taken to integrate TB-HIV care in countries around the world, and an estimated 8.4 million lives were saved through integrated and collaborative TB-HIV activities, opportunities are still being missed.

While WHO recommends that all patients with presumptive or diagnosed TB should be tested for HIV only 51% of people diagnosed with TB were tested for HIV in 2014. Also only 47% of people on ART were screened for TB; and only 50% of the estimated number of PLHIV who developed TB were diagnosed and provided with TB care. For this reason, The International Union Against Tuberculosis and lung Disease has committed to addressing this deadly co-epidemic through an integrated care approach known as Integrated HIV Care for Tuberculosis Patients Living with HIV/AIDS (IHC). This approach aims to strengthen collaboration and build capacity of the countries' general health systems to deliver high-quality HIV and TB care. Dr Anthony Harries, Former Senior Advisor and Director, Department of Research, International Union Against Tuberculosis and Lung Disease (The Union) notes that over 75% of PLHIV who contract TB are in countries of Sub Saharan Africa, like Malawi. He says ART suppresses HIV replication and this leads to a gradual increase in CD4 cell counts and it is these cells that protect one against TB.

When isoniazid preventive therapy (IPT) is added to ART, it further reduces risk of TB. Thus giving both ART and IPT to PLHIV will reduce TB incidence and indirectly lessen TB mortality. This is of particular benefit in high HIV-TB burden settings such as Malawi, says Dr Harries. 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. Let us not forget that one of targets of Goal 3 of the United Nations Sustainable Development Goals (SDGs) is to end AIDS and TB by 2030. It will not be possible to achieve this without scaling up TB-HIV collaborative care and control.

Josephine Chinele, Citizen News Service - CNS
December 12, 2016

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