'When a virus (HIV) and a bacteria (TB) can work so well together, why can't we?'

1st December: World AIDS Day
Words of UNAIDS Executive Director Dr Michel Sidibe which I heard first at the Stop TB Partners' Forum in 2009: 'When a virus (HIV) and a bacteria (TB) can work so well together, why can't we?,' still hold true as all countries where TB and HIV co-infection is setting off alarm bells haven't yet fully implemented the TB-HIV collaborative activities as recommended by the WHO. "Countries where the TB epidemic is driven by HIV, such as Zimbabwe and other southern African countries, it is important that ministries of health adopt the 12 point package of collaborative TB HIV activities recommended by WHO" said Dr Riitta Dlodlo, TB-HIV Programme Coordinator, International Union Against Tuberculosis and Lung Disease (The Union) who is also a member of the TB/HIV Working Group of Stop TB Partnership housed in WHO Geneva.

The TB-HIV collaborative activities recommended by WHO in March 2012 are as follows:

A. Establish and strengthen the mechanisms for delivering integrated TB and HIV services
A.1. Set up and strengthen a coordinating body for collaborative TB/HIV activities functional at all levels
A.2. Determine HIV prevalence among TB patients and TB prevalence among people living with HIV
A.3. Carry out joint TB/HIV planning to integrate the delivery of TB and HIV services
A.4. Monitor and evaluate collaborative TB/HIV activities
B. Reduce the burden of TB in people living with HIV and initiate early antiretroviral therapy(the Three I’s for HIV/TB)
B.1. Intensify TB case-finding and ensure high quality antituberculosis treatment
B.2. Initiate TB prevention with Isoniazid preventive therapy and early antiretroviral therapy
B.3. Ensure control of TB Infection in health-care facilities and congregate settings
C. Reduce the burden of HIV in patients with presumptive and diagnosed TBC.1. Provide HIV testing and counselling to patients with presumptive and diagnosed TB
C.2. Provide HIV prevention interventions for patients with presumptive and diagnosed TB
C.3. Provide co-trimoxazole preventive therapy for TB patients living with HIV
C.4. Ensure HIV prevention interventions, treatment and care for TB patients living with HIV
C.5. Provide antiretroviral therapy for TB patients living with HIV

Dr Riitta adds: "I am pleased to confirm that all our countries have adopted and adapted these activities and national policies and guidelines do exist. Most countries have excelled in providing services for component C where only C5 lags behind, ie. antiretroviral therapy (ART) uptake among HIV positive TB patients remains unacceptably low (approximately 50%).  There is urgent need for national TB programmes to work with national AIDS programmes and decentralise provision of ART initiation and follow up services. This can be done if nurses are empowered to play a leading role in ART and HIV care."

Dr Riitta who works on TB-HIV issues in Zimbabwe, shared "My experience is mainly from Zimbabwe and it is largely positive: so much can be done when we put our will into it!  It is important to provide decentralised and integrated TB and HIV diagnostic and treatment services. Documentation of service expansion is critical: recording and reporting of patient cohorts enrolled in TB HIV care and their treatment outcomes forms a foundation for the ministries and other health institutions to monitor performance of services."

"Collaborative TB HIV services can provide a lifeline to patients!  It is important for all persons with TB (and even those people who are to be evaluated for TB) to come forward and embrace the routine offer of HIV counselling and testing – unless they already know their (recent) HIV status. If found to be HIV positive, these services are an entry point to HIV care and ART – that should be available to TB HIV patients as soon as possible, at about 2 weeks as long as no medical contraindications exist. There is no need for further tests, such as CD4 cell counts, that may delay ART initiation" said Dr Riitta.

To mark World AIDS Day, Dr Riitta said to Citizen News Service - CNS: "I wish that our patients, their families and communities would also demand TB and HIV screening of household contacts and partners: in this way all the other persons who may need TB treatment and /or ART and HIV care could be identified early."

TB is preventable, and curable. Any life lost to TB is unacceptable, in any part of the world. Studies have shown the enormous benefit of ART in terms of public health and social justice. There is no reason why governments should not do all they can for a better tomorrow.

Bobby Ramakant - CNS 

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