HIV-TB threats globally

Chhatra Karki - CNS
(First published in Kapan Online, Nepal on 1 December 2013) 
Since the governments have not taken effective integrated steps for controlling HIV-TB, the challenges to control the two diseases continue to compound and experts rue over the absence of effective programmes to prevent TB infection in HIV infected people. It is well known that there is a much higher possibility of TB infection in people living with HIV (PLHIV) than in those who are HIV negative. Researches reveal that they have an estimated 21 to 26 times greater risk of developing active TB once infected.  In 2012, among the 35.3 million PLHIV in the world, 11.8 million were also infected with TB. Globally 320 000 PLHIV co-infected with TB lost their lives in 2012. The number of these deaths would have been less, if somehow TB infection in them was prevented.

The World Health Organization (WHO) has urged governments and responsible stakeholders to take an initiative to control the spread of TB in PLHIV and vice versa. In 2012, 4.1 million PLHIV were tested for TB and 46% of the TB patients knew their HIV status. However, only 57% of the TB patients infected with HIV were on anti-retroviral treatment (ART) and 80% received Cotrimoxazole Preventive therapy (CPT).

The International Union Against Tuberculosis and Lung disease rues that the challenges have been added as there is poor coordination between TB and HIV treatment programmes. Furthermore, majority of the TB treatment clinics do not act as HIV testing points. The experts suggest that patients, who are suffering from both TB and HIV, should be retained in HIV care unit after the treatment of TB.

According to National Centre for AIDS and STD Control (NCASC) Nepal, in 2012, the number of PLHIV stood at 50,200 in Nepal, out of which 2.4% were also found to be suffering from TB. A greater incidence of HIV infection was found in Female Sex workers (FSWs), People who inject drugs (PWIDs) and labour migrants. Although the first patient of HIV was reported in 1988 in Nepal, the infection massively increased after 1996. Though the government of Nepal has the goal to reduce new HIV infections by 50% and HIV related deaths by 25% by 2016, the challenges have been added due to PLHIV getting co-infected with TB.

“Though we have integrated programmes to control HIV-TB, we are unable to ensure effective treatment for all infected ones,” said Dr. Naresh Pratap Kc, Director of NCASC. He further said that the TB clinics and HIV Testing Centres are not available all over the country. On a different note, the Global Fund to Fight AIDS, Tuberculosis and Malaria has come forward to invest money in the eradication process of HIV, TB and Malaria in Nepal. Similarly, integrated programmes have been launched in Dhanusha, Doti and Rupandehi districts, but not throughout the country, in an effort to limit the infection.

Experts suggest that the HIV-TB co-infections could be lowered down, if the existing resources are properly utilized. “ART should be ensured earlier for all PLHIV, as this is the most important way of preventing tuberculosis. TB preventive effects of ART can be further increased by the addition of isoniazid preventive therapy,” said Dr Anthony Harries, Senior Advisor at the International Union Against TB and Lung disease (The Union)

Chhatra Karki, Citizen News Service - CNS
December 2013
(First published in Kapan Online, Nepal on 1 December 2013)