Integration of the TB and HIV/AIDS National Programmes

Under the joint initiative of NACO (National AIDS Control Organisation) and RNTCP (Revised National TB Control Programme), the ‘National Framework for Joint HIV/TB Collaborative Activities’ was revised for strengthening HIV-TB collaborative activities across the country. The National Technical Working Group for HIV/TB — comprising key officials from NACO and the Central TB Division---ensures: 1) fast tracking of patients co-infected with HIV and TB; 2) adherence to treatment guidelines; 3) appropriate training of medical officers posted at ART centres on TB diagnosis and treatment. The intensified HIV/TB package of activities includes routine offer of HIV counseling and testing for all TB patients and linking of all the identified HIV/TB patients to CST including treatment for TB, other OI and ART.

The next phase of National AIDS Control Programme involves the drawing up of the National AIDS Control Programme Phase IV plan (NACP IV), which will run from 2012 to 2017.
To give specific inputs into this, 15 Working Groups ( with 20+ sub-groups), with representation from different stake holders-- including government departments, Civil Society, Development Partners and Private Sector -- have been set up.

Indian Network for People Living with HIV/AIDS (INP+) is part of the working group on Care and Support, Stigma, Greater Involvement of People Living with HIV. Along with GHA India (Global Health Advocates, India), it has prepared a list of recommendations for the Government of India to consider while planning the next phase of National AIDS Control Programme. NACO is expected to examine these recommendations while drawing up the National Strategic Plan in September 2011 for NACP IV.

These recommendations are based on a national consultation among all stakeholders, including civil society, PLHIV and funding agencies. INP+, with technical assistance from GHA India, has done 7 nation-wide regional consultations  ( in Orissa, Calcutta, Pune, Imphal, Chennai, Lucknow and Delhi) where over 700 number of representatives from 21 states came together to discuss the gaps in the programs specific to TB-HIV co-infection and develop the recommendations for that.

The recommendations cover three main areas: (i) prevention of TB among PLHIV (ii) improved ART treatment and early checking for resistance to first line of ARTs  for people living with HIV/AIDS as well as with the TB-HIV co -infection and (iii) mainstreaming HIV into the health system.

A major recommendation of TB/HIV consultations calls for early scale up and availability of better/faster TB testing technology. These include the roll out of the molecular based NAAT (Nucleic Acid Amplification Test) to provide early diagnosis of pulmonary TB and Extra Pulmonary TB.

Currently less than 5 percent of PLHIV in India are automatically tested for TB.

The Stop TB partnership in its global plan to stop TB for 2011-2015 targets an 80 percent detection and treatment rate for TB among PLHIV by 2015 through scale up in testing for TB among PLHIV, earlier ART treatment and early and regular TB treatment.

K. K. Abraham, President of (INP+), pointed out that,” These tests in future will also help to bypass the  reluctance of the health care provider in taking pus/blood samples (or Cerebrospinal Fluid samples in the case of Extra Pulmonary TB). INP + has made three other recommendations also to: ensure a better quality diagnosis for early detection of first line treatment failure cases in order to save lives of PLHA waiting to get second line of ART; use of Alternate Drugs (Tenofovier based) for first line ART; and involving the PLHIV community in monitoring and evaluation”. 

Outlining the set of points that emerged from the national consultations with regard to TB/HIV co-infection, Mamta Jacob, Advocacy Coordinator of GHA India, said, “Steps should be taken to introduce Isoniazid Preventive Treatment (IPT) for the eligible PLHIV. People living with HIV who are routinely exposed to TB should be protected against becoming ill with TB. Such protection is
cheap and simple—a daily dose of isoniazid would help in preventing an HIV positive person who has latent TB infection from developing life threatening active TB. However in order to do that better TB diagnostic tools, like molecular based NAAT (Nucleic Acid Amplification Test) tests, which are faster and more accurate, are needed in future to correctly diagnose TB in HIV positive people.”

She pointed out that, “There should also be easy and free of cost availability (at the district hospital level) of diagnostic methods like CT scans, Ultrasounds and MRIs for HIV positive people. These methods which are very important in diagnosing extra pulmonary TB in PLHIV are currently available only in 267 medical colleges nationally and are not free for HIV positive people. Apart from this, infection control measures in ART (Anti retro viral Treatment) centres-- like safe disposal of
sputum—are also very important to prevent and reduce cross-infections of TB among PLHIV.”

The final set of recommendations outline a plan for improving case findings for TB/HIV co-infection by: targeting training of partners who work in affected networks like MSM and drug users; establishing a higher number of integrated centres where testing for both HIV and TB can take place; and strengthening referrals and reporting between ART centres and TB testing centres (Link Plus and DMCs).

It is hoped that these recommendations will go a long way to treat and prevent the spread of
tuberculosis, a global disease that kills one person every 20 seconds, and not only disproportionately affects people living in poverty, but is also makes people live in poverty.

Shobha Shukla - CNS

Published in:
The States Times, Jammu and Kashmir, India
Wikio News, Africa