Why The World cannot fight AIDS by ignoring TB?

Francis Okoye, CNS Correspondent, Nigeria
Medical and historical evidence now abound, showing that the world cannot fight AIDS by ignoring TB. In 2015, the world recorded 10.4 million new TB cases of which people living with HIV (PLHIV) accounted for 1.2 million (11%) cases. There were an estimated 1.4 million TB deaths, with 400,000 deaths resulting from TB disease among PLHIV.

The risk of developing TB is 26-31 times greater in PLHIV. Nearly 75% of PLHIV who contract TB live in sub-Saharan Africa. In some countries in this region, up to 80% of individuals with active TB disease are also HIV-positive. TB-HIV co-infection increasingly poses a risk to people living in other regions as well. Around 30% of all people who become sick with TB live in Asia, where TB accounts for 40% of AIDS related deaths. Eastern Europe too has the fastest-growing HIV epidemic globally, making this region vulnerable to increasing TB-HIV co-infection as well. In a webinar organized for the media by Citizen News Service (CNS), on the eve of World AIDS Day 2016, experts like Dr Anthony Harries, former Senior Adviser and Director, Department of  Research at the International Union Against Tuberculosis and Lung Disease (The Union), Dr Ishwar Gilada, President AIDS Society of India, Nomampondo Barnabas, Civil Liaison Officer at the Union, and Monisola Ajiboye- an MDR-TB and HIV/AIDS survivor, among others, expressed their views on ‘To end AIDS by 2030, we have to stop neglecting TB.’ Dr Harries informed that while anti retroviral therapy (ART), protects PLHIV from TB at high CD4 cell count, isoniazid preventive therapy (IPT) adds to this protection. Benefit of adding IPT to ART results in 36-60% reduction in TB as compared to using ART alone. Thus giving ART and IPT together to PLHIV will reduce TB incidence and hence indirectly reduce TB mortality.

Also all TB patients should be tested for HIV, and if they test positive start cotrimoxazole preventive therapy CPT as soon as possible. Given together with anti TB treatment, CPT brings about a 25-46% mortality reduction. If ART is added to it, we get 64-95% reduction in mortality. ART and CPT given to patients with HIV-TB reduces TB mortality significantly and by preventing recurrent TB it also reduces TB incidence. Dr Gilada explained that while TB is 100% curable, TB control programmes are beset with shortage of funds. On the other hand HIV, which 0% curable but 100% preventable, has plenty of funds budgeted for it. Nomampondo Barnabas speaking on role of civil society organisations (CSOs), stressed on the importance of CSOs embarking on educating the TB community about their rights by using the same advocacy methods as applied to HIV community if we want to end AIDS by 2030. Monisola Ajiboye of Nigeria shared her experience of living with TB-HIV. She stated the need to create awareness about TB in the community. “In Nigeria there still are communities, especially in rural areas, who know very little about TB, even though TB kills faster than HIV. Every month we record 10 new TB cases in PLHIV. Some of them, including children have MDR-TB. We recently lost a PLHIV to TB due to lack of nutrition. So nutritional support to TB patients is very important,” she said.

WHO estimates that between 2000-2014, 8.4 million lives have been saved through integrated and collaborative TB-HIV activities. Still a lot more needs to be done. In 2014, only 47% of people on ART were screened for TB; only 51% of people diagnosed with TB were tested for HIV; and only 50% of the estimated PLHIV who developed TB were diagnosed and provided with TB care. These gaps need to be filled up. TB being curable and preventable, it is unacceptable that anyone, including PLHIV, die of TB. Funders need to take inputs from affected communities to design programmes for TB control. Integrated care is critical to saving lives from TB-HIV co infection. The Union’s integrated care approach, called HIV care for TB patients living with HIV/AIDS (IHC), aims to strengthen collaboration and build capacity of affected countries general health system to deliver high quality HIV and TB care.

Francis Okoye, Citizen News Service - CNS
December 10, 2016