Double up efforts to fight the double epidemic of TB-HIV

Alice Tembe, CNS Correspondent, Swaziland
It is no news that the TB bacteria and the Human Immunodeficiency Virus (HIV) together make up a co-epidemic that presents compounded complications in patients who host them, healthcare workers who have to manage the diseases, advocates and researchers fighting for answers as well as communities who have to cope with the disastrous effects of the co-epidemics.

Sonto Lukhele (name changed), a Community Treatment Supporter, explained that the community bears the burden of both HIV and TB not only during the manifestation of the diseases, but even after the patient recovers or dies. She shared that when she visits the homes, the family verbally disassociate themselves from the patient, telling her ‘Your patient has not woken up or eaten all day, maybe he needs his bedding changed” The patient and anything pertaining to him/her seems to belong to the community care worker. Even after death, the community care workers tend to take responsibility to pack-up the patient’s belongings and clean up the room used by the patient.

Scientists have already proven that there is a significantly high chance of TB development among HIV positive patients compared to HIV negative patients. The World Health Organisation (WHO) has highlighted that, on postmortem, half of the PLHIV who died had undiagnosed TB.  It is however disheartening that in the era where HIV can be treated and managed and TB can be cured, these epidemics still account for alarming deaths. Dr K S Sachdeva, Deputy Director General at NACO in New Delhi, who shared statistics on India, noted that an increasing number of HIV positive patients are now receiving TB preventative therapy. But more needs to be done and there is a great need for co-location of TB and HIV facilities, and infection control in the healthcare centres.

Humankind can keep the candle of hope burning now that the WHO has endorsed the 9-month treatment regimen for multi drug resistant TB (MDR-TB) a great leap forward from the 24 months regimen that is currently used. This is an improvement over the more costly, highly toxic and long treatment that results in severe side effects, including permanent hearing loss, psychosis and organ damage. However, the new treatment regimen is to be used with caution and the Who has issued clear recommendations and guidelines on the do’s and dont’s. In this respect, governments through their National TB Control Programmes will require an overhaul on approach, execution and management of TB. Swaziland hosted an AIDS Conference prior to the 2016 TB and AIDS conferences in Durban, and one of the major commitments was to initiate treatment of people living with HIV immediately after diagnosis, irrespective of their CD4 cell count. The aim is to keep the immune system strong (high CD4 count) and minimize opportunistic infections, including TB among HIV positive patients. This indeed is a very positive move.

In addition to extensive community education to increase public awareness and community ability to support patients and families, the International Union against Tuberculosis and Lung Disease (The Union) has recommended the following key steps for prioritization: Incorporate the 9-month MDR-TB treatment regimen within clinical guidelines; ensure a steady supply of necessary medicines; and train healthcare workers to administer the new regimen so that patients can begin benefiting from it as quickly as possible.

Alice Tembe, Citizen News Service - CNS
July 26, 2016