CNS: Articles of Nenet L Ortega

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Integrating TB-HIV services with maternal and child healthcare

Nenet L Ortega, CNS Special Correspondent

TB is the third leading cause of death for women worldwide in their childbearing years. Maternal TB leads to poor outcome for the mother and child, especially when the mother is infected with HIV. Intensified case finding, isoniazid preventive therapy (IPT), and infection control ("3 Is") remain the cornerstones of TB-HIV collaborative activities, but have not been systematically integrated into maternal and child healthcare (MCH) settings.

Responding to MDR-TB from the ground

Nenet L Ortega, CNS Special Correspondent

Photo credit: CNS: citizen-news.org

Community participation indeed play a major role in bringing TB care and control services to populations that are geographically isolated, marginalized, and/or belong to disadvantaged groups. Community based non government organizations bring together key players from government, private sectors, faith based groups, TB patients, their families and survivors to work through partnership and inclusive collaboration–-these are key to effective and low cost TB services in the communities. Examples of creative, effective and low-cost solutions to improving MDR-TB treatment outcomes, supported by the Lilly MDR-TB Partnership and implemented in several high burden countries, were shared during the 45th Union World Conference on Lung Health in Barcelona.

Community demands shorter and safer treatment for drug-resistant TB

Nenet L Ortega, CNS Special Correspondent

Photo credit: CNS: citizen-news.org

According to WHO's Global Tuberculosis Report 2014, an estimated 480,000 people developed multidrug-resistant TB (MDR-TB) worldwide in 2013 and an estimated 210,000 died from it. However only 136,000 were diagnosed and only 97,000 patients (one out of five) could be started on MDR-TB treatment in 2013, with the gap between diagnosis and treatment widening between 2012 and 2013 in several countries. On an average, an estimated 9% of people with MDR-TB had extensively drug resistant TB (XDR-TB).

Preparing frontline health workers for community-led change

Nenet L Ortega, CNS Special Correspondent

Photo credit: Nenet L Ortega/CNS

If care for people affected by TB is going to be truly patient-centred, TB services will have to be demand driven and communities will need to be actively involved in the planning and implementation of care. A genuine patient centred TB service rests upon the readiness of its providers, the facility, the TB patients themselves and the whole community. Ideally, services in a TB facility should be rendered by trained health practitioners like the doctors, nurses and other allied health workers.

Meaningful community participation to end TB

Nenet L Ortega, CNS Special Correspondent

Photo credit: Nenet Ortega/CNS

The theme for this year’s 45th Union World Conference on Lung Health, taking place in Barcelona, Spain, is focused on community driven solutions to address health challenges of the next generation. According to Jose Luis Castro, the Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union), the conference calls on everyone to explore the need of generating health solutions that would address health challenges involving the different stakeholders, policy makers and, most especially, the people in the communities being served.

Programmatic Management of MDR-TB by Private Health Sector in the Philippines

Nenet Ortega, CNS Correspondent, Philippines

Several Asian countries, including Philippines, come in the bracket of 22 high TB burden countries in the world. The Department of Health of Philippines, implements the National Tuberculosis Control Programme (NTP) through its health offices and units of 81 provinces and 1,634 municipal and city governments. Direct services are provided mainly at the primary health centres that utilize the Directly Observed Treatment Short Course (DOTS) strategy to treat TB.

Nenet Ortega, CNS Correspondent, Philippines
A government hospital is usually the preferred facility to seek medical and clinical consultation by people in a rural community and they do come when they are already sick. Everyday hundreds of clients seek consultation. A review of the out patients census and data for the first two quarters of 2014 in a hospital in Philippines showed that the top three leading causes for which patients sought medical and clinical consultation were--TB, upper respiratory tract infection/asthma and pneumonia.

Nenet Ortega - CNS
Two decades ago, people living with HIV and AIDS (PLHIV) including their families had been stigmatized in all areas of social life, from communities where they lived and in areas where they normally do their daily grind.

Nenet Ortega - CNS
Gender diversity has a long and rich history in the Asia-Pacific region. Most societies are patriarchal, leaving women in general as second-class citizens who face significant economic, social and health challenges compared with men. The situation is even worse for transgenders and sex workers. Stigma and discrimination force most to live on the margins of society. Due to fear, discrimination and isolation, they are often unable to seek out and obtain adequate health and social services. Partly for those reasons, they have long experienced HIV and TB prevalence far above national averages.

Nenet Ortega - CNS
The Global Fund has helped governments and civil society organizations to ‘jump start’ their programmes by funding national HIV, tuberculosis (TB) and malaria initiatives. This has included support to community work, and ART provision etc. This has also helped stimulate domestic health spending, as governments are expected to provide counterpart funds, and eventually to address issues of longer-term sustainability.

Nenet Ortega – CNS
“Getting to Zero” is UNAIDS’ strategic mantra for attaining zero new infections, deaths and discrimination. To get there, countries are expected to adopt innovating preventive approaches, scale up and scale out treatment care and support, and advance human rights while capitalizing on gender equality to mitigate discrimination and stigma.

Despite all efforts to increase access to affordable antiretroviral (ARV) pills over the past years, all people living with HIV (PLHIV) who need them most are still struggling to have them in developing countries. The access to these essential medicines is further decimated by the ever changing rules on trade globally. Brazil was a pioneering country where a compulsory licensing mechanism was opted specifically for Efavirenz and this led to the reduction in the cost of the drug and helped put many more PLHIV on treatment within same resources. According to Francisco Viegas Neves da Silva, this initiative on putting flexibility in the TRIPS is economically efficient while at the same time, improved access to drugs. This pioneering action of Brazil inspired community activism for greater access to life saving drugs.

Washington DC is the host to the 19th International AIDS Conference (AIDS 2012) with about 24,000 registered delegates coming from all around the world. International conferences such as this one is an opportunity and a venue to get updates, innovations and new strategies in addressing HIV and turn the tides to achieve the 2015 targets of zero HIV infection, zero HIV related death and zero HIV related stigma and discrimination. US President Barack Obama had earlier made a call that AIDS free generation is possible. The conference provided loads of information on practices that worked in communities all over the world, including bio-medical breakthroughs and the latest innovations on treatment for people living with HIV (PLHIV).

HIV related epidemiological trends in Asia are no less alarming than those in Africa. With increasing number of new HIV cases among the men who have sex with men (MSM) and transgender populations in the region; the critical need to sustain responses, programmes and mobilize optimal resources to address needs of sex workers and injecting drug users (IDUs), and growing requirement to provide life-long treatment, care and support for all people living with HIV (PLHIV) in the region, the XIX International AIDS Conference (AIDS 2012) cannot afford to ignore HIV in the Asian region.