A call for collaborative TB-HIV treatment

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
It is high time that there is a collaborative TB-HIV treatment if we are to have quality life for people living with HIV (PLHIV). Taking medication for HIV daily is already a burden and for TB co-infection the additional tablets to be swallowed by a patient daily become more than a mouthful. To understand the pill burden remember one day you went down with a common cold and had to take two or three tablets for a prescribed treatment time. The moment you got better you stopped the treatment without finishing the course.

For PLHIV on life treatment, stopping medication is not an option. Anti retroviral (ARV) drugs have to be taken daily for life. With a weakened immune system, a PLHIV is prone to get opportunistic infections with TB topping the list. TB is caused by TB bacillus and is a major killer, surpassing HIV/AIDS. Recently, at a workshop for meaningful involvement of PLHIV (MIPA) organised by the National AIDS Council, in Gweru, Zimbabwe, the provincial medical director for Midlands Province, Dr Charles Moyo said it was imperative that PLHIV take precautionary TB medication. “For people living with HIV, it is important that they take isoniazid tablets as a measure to prevent TB infection. The tablets are taken for six months and this helps in TB prevention,” said Dr Moyo. Being a journalist and a PLHIV, I asked why this medicine is not offered when one collects their ARVs. Most people in the meeting professed ignorance of this prevention treatment. They, however, lamented the increase in pill burden with the addition of the TB prevention medication.

“This is the first time I am hearing that there is TB prevention. I have been living with HIV for the past ten years and 5 years ago I got TB. So I am surprised, why the prevention is not offered to one when starting ART because getting TB-HIV co infection and the amount of tablets to be taken is too much,” said Emmanuel Gasa, an activist and founder for internally displaced people in Zimbabwe. Gasa went on to say that knowledge is power and that he would enquire about isoniazid preventive therapy (IPT) at his local clinic. At a press briefing at the recently held 21st International AIDS conference in Durban, South Africa civil society demanded collaborative TB-HIV treatment as a matter of urgency. Civil society liaison officer at the International Union Against TB and Lung Disease (The Union), Nomampondo Barnabas said that integration should not just be about one-stop services, it should also encompass a fixed dose combination for dealing with TB co-infection. “Currently there are just too many tablets that one has to take when co-infected with TB-HIV. The pill burden is high and this adds to lack of adherence. I am not a medical person, but I feel there is an urgent need to come up with one pill, combining TB and HIV treatment,” said Barnabas.

Barnabas has lived with HIV for nearly two decades and called on policy makers to listen to affected voices. “Before any programming is done, there is need to listen so that we do not lose gains made in the fight against HIV and TB,” said Barnabas. The TB-HIV burden is also high in Zimbabwe, with 70% of TB patients testing HIV positive too. Dr Zishiri, Country Director of The Union in Zimbabawe said that gains made in the fight against HIV and TB must not be lost. “Through our Challenge TB, we have, through the Ministry of Health and Child Care, integrated TB-HIV services around the country but I believe more can still be done to encourage adherence and lessen the pill burden,” Dr Zishiri said. He called on pharmaceutical companies to heed the call. “It is something important that pharmaceutical companies can think of to combine TB-HIV treatment,” added Dr Zishiri. According to the Global Report on TB, TB remains the world’s deadliest communicable disease. “Of the 9 million people estimated to have developed TB, 1.5 million died from the disease. Of these 360 000 were HIV positive,” the report noted. TB screening for all PLHIV should be an on-going process. Shingirayi Matogo, an activist and founder member of Clear Vision, an organisation working in the community of Glen View in Harare, Zimbabwe, said it is sad to see people still dying of TB—a disease that is preventable and curable.

“It is sad to still have people dying of TB in this age. It is not always that a person infected with TB coughs. Recently I was bereaved in the extended family, when a young life was lost to TB. That was a premature death. The young man never coughed but I feel that the moment he tested HIV positive, they should have screened him for TB. By the time he was admitted it was too late and we lost him,” said Matogo. A participant at the MIPA workshop said he had on two occasions suffered from TB. “I have been on ART since 2004 and am happy to say I am still on first line treatment. My concern is that I fail to understand why I repeatedly keep getting infected with TB. The first time was before I knew that I was HIV positive. So as I was receiving TB treatment I was screened for HIV and found to be positive,” he said.

 “In 2014, I got a rebound of TB and the treatment was long and painful, as it was multi drug resistant TB (MDR-TB) this time. I had to get injections daily for six months and took a handful of tablets. Should not PLHIV on ART, be screened periodically for TB,” said the participant.

Health personnel should educate PLHIV about co-infections, especially TB and also offer preventive treatment for it. In September 2015, governments of all the UN member states committed to achieve the 17 Sustainable Development Goals (SDGs) one of which is to end  TB and HIV/AIDS by 2030. If PLHIV continue to die of TB, the gains made in the fight against HIV and TB will be eroded.

Catherine Mwauyakufa, Citizen News Service - CNS
August 1, 2016