Integrating TB/HIV Services in Zimbabwe: A Key Public Health Priority

Harare, ZIMBABWE - In Zimbabwe, there is a wide recognition of the need to integrate TB and HIV services but for people living with HIV (PLHIV), it is not evident, said Martha Tholanah, Coordinator of the International Community of Women Living with HIV (ICW) Zimbabwe Chapter. While Zimbabwe has made progress in implementing collaborative TB/HIV activities, much work still remains to be done to make them an integral part of the health service. Tholanah said that civil society in had also failed to spearhead the integration of TB and HIV in the country. “There is too much fragmentation. National AIDS Council (NAC) needs to strengthen coordination. I think we (CS) have always made much noise about demanding NAC to be accountable, but I do not think we have been accountable ourselves,” said Tholanah.

According to the International Union Against Tuberculosis and Lung Disease (The Union), in countries with a generalised AIDS epidemic, HIV infection remains the leading risk factor for the development of tuberculosis.  In fact, TB is frequently the first opportunistic illness in people living with HIV, making TB services a critical entry point for HIV diagnosis and care.Early diagnosis, timely initiation of treatment for both diseases and careful monitoring are essential to treat TB in PLHs and identify HIV infection in people with TB.

Across sub-Saharan Africa, the dual epidemic of TB and HIV continues to be a major factor in morbidity and mortality among PLHIV, undermining efforts to prevent and control HIV.  In Zimbabwe, it is estimated that approximately 80% of TB cases are co-infected with HIV. Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population. Against this background, Tholanah added that civil society in Zimbabwe needs to be more accountable in order to enhance the TB/HIV integration.

“I think if we had been accountable we would have been able to report to NAC and AIDS and TB Unit on our activities. As civil society, we should be able to see the two complementing and working closely together and not having this huge imbalance in terms of resources. We also have not made much noise about the 15% Abuja Declaration of 2001,” she said.

Dr Riitta Dlodlo, Dr Riitta Dlodlo, TB-HIV programme coordinator and a representative of The Union on the Stop TB Partnership's TB/HIV Working Group said that though HIV prevalence is decreasing in the country, TB continues to a major health threat among PLHIV.

“The HIV prevalence in the reproductive aged general population in our country is decreasing.  However, all persons living – presently - with an HIV infection face an increased risk of developing active TB disease.  Even persons who are on effective ART have a higher risk of TB than an HIV-negative person (though of course, the risk is lower than in a PLHIV who is not on ART).  We need to expand integrated TB HIV services and sustain them for years to come” said Dlodlo. Dlodlo also bemoaned the lack of comprehensive TB/HIV services in Zimbabwe.

“If one resides in Bulawayo, one is truly lucky because the network of decentralised and integrated TB HIV services is very well ‘developed’: at least nine of the 19 municipal clinics provide ART initiation services in addition to ART follow up and of course, there are Mpilo and UBH OI/ART clinics.  TB diagnostic and treatment services were decentralised to all clinics almost 20 years ago,” she said.

“Unfortunately, other large cities may not have reached this stage yet.  For example, in Harare, only one (out of 12) polyclinics has years long experience in ART initiation.  This is the polyclinic in Mabvuku. If one lives in rural areas, some districts are more advanced than the others in this regard.”

Chief K.Masimba Biriwasha - CNS
(The author serves as Editor-in-Chief of iZimbabwe, born in Zimbabwe, is a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)