Integrating TB and HIV Care

Despite the fact that tuberculosis (TB) is curable and human immunodeficiency virus (HIV) infection is treatable, 350,000 people co-infected with the two diseases died in 2010, according to the World Health Organization (WHO). For most healthy people, the risk of developing active TB disease is very low, but, for people living with HIV (PLHIV), the risk is 20-30 times higher because HIV weakens the immune defence system. The two diseases are closely linked because TB is frequently the first opportunistic infection in PLHIV. Globally, millions of PLHIV are also at risk of developing TB. According to the WHO, TB caused one in four HIV/AIDS-related deaths in 2010.

Each year an estimated one million people (around 80% of whom live in sub-Saharan Africa) need simultaneous treatment for both TB and HIV. Caring for them is one of the major challenges facing health care systems in the limited-resource settings with the highest burdens of these closely linked diseases. The International Union Against Tuberculosis and Lung Disease (The Union) has been working with TB and AIDS control programmes in Africa and Asia since 2004 to mitigate this dual burden of disease by helping health care providers collaborate effectively at every level of the health care system. Using general health services, the Integrated HIV Care for TB Patients Living with HIV/AIDS (IHC) Initiative has screened and treated thousands of patients in Benin, the Democratic Republic of Congo, Uganda, Zimbabwe and Myanmar. 

Now The Union has turned those years of practical experience into Implementing Collaborative TB-HIV Activities: A Programmatic Guide. Using a straightforward question-and-answer format, this guide covers The Union’s experience from the point where health services are delivered to the level of policy-making institutions within a country. 

Primary health workers can use the guide to find practical tips for their daily work, while managers and policy-makers may find solutions to the constraints they face. Suggestions are also provided to programme managers and health workers on how to plan, organize and mainstream collaborative TB-HIV activities into their TB and HIV services within the general health system. 

One of strengths of The Union is its in-depth understanding of health systems, as well as the staff, patient and community-related factors that can create barriers to collaboration. Key elements of IHC have been operational research to identify such barriers and training to help teams find ways to overcome them.

“Many countries have made progress in implementing collaborative TB-HIV activities”, says Dr Paula I Fujiwara, Director of The Union’s TB and HIV Department. “However, others still face challenges in making these activities operational within their national TB and AIDS programmes and general health services. We hope the guide will help them scale up this critically needed approach to TB-HIV care”.

Citizen News Service (CNS)