African health officials face TB crisis

By Emmanuel Camillo, Associated Press, August 26, 2005

MAPUTO, Mozambique -- Mozambican health officials know they are being overwhelmed by tuberculosis - and fear the crisis may be even worse than thought.

But Thursday's declaration by African health ministers of a tuberculosis emergency on the continent "will certainly help tackle the problem," Candido Mindu, head TB doctor at Maputo's busy Machava hospital said Friday.

The ministers attending a World Health Organization regional meeting in Mozambique's capital also appealed to donor governments to devote more resources to what is regarded as one of the world's most forgotten diseases.

WHO's Stop-TB department has asked for $2.2 billion in new funding for TB control in Africa during 2006-2007, saying that tuberculosis expenditure is dwarfed by spending on AIDS.

TB is killing more than half a million people a year on the world's poorest continent. In Mozambique, 30,000 cases were diagnosed in 2004, but this is likely to be an underestimation because many people in rural areas are unable to seek treatment, said Mozambique's Deputy National Director of Health Martinho Djedje.

"It's really a worry for our country," said Djedje. "We need to check what is happening in the rural areas, but due to problems like poor roads we can't."

TB is spread by airborne bacteria that settle in the lungs and cause long-term infection. Many people who are infected do not become ill themselves but can spread the disease.

The annual number of new TB cases in 18 worst hit countries in Africa has quadrupled since 1990 and continues to rise, fueled by a lethal mix of poverty, HIV/AIDS, which weakens the immune system, and understaffed, crumbling health systems.

"We have frequently gone into denial when faced with unpleasant, unpalatable facts and now we are hearing from governments in Africa that they are not going into denial but that they are facing up to a horrendous situation forthwith," said Nobel Peace Prize laureate Desmond Tutu, who spent 20 months in hospital as a teenager with TB.

"We call on the international community, which was so tremendous in its fight against another epidemic, apartheid, to show the same commitment to deal with TB and HIV/AIDS," Tutu said Friday in a telephone conference call from his home in Cape Town, South Africa.

No new reliable test for the disease has been developed in a century and there has been no new treatment for decades.

"Africa is the one region where TB is totally out of control," said Karin Weyer, a TB expert with South Africa's Medical Research Council, which forecasts that South Africa will have 300,000 cases and 30,000 deaths from TB this year - a fatality rate of 10 percent compared to a fatality rate of 3 percent to 5 percent before the arrival of HIV, the virus that causes AIDS.

The Maputo declaration "is a good first step but good declarations need to be followed by action," Weyer said Friday.

Tuberculosis is the most common infection among - and leading killer of - people living with HIV/AIDS. Of the estimated 25 million Africans now living with HIV, about 8 million also harbor the bacillus that causes TB. Each year, 5 percent to 10 percent of these 8 million develop active TB, according to WHO figures.

In the late 1970s and early 1980s, Mozambique, Tanzania, and Malawi were among the first to apply what became the global TB control strategy, a program under which trained workers monitor patients to ensure drugs are taken properly.

The cost of the six-month course of drugs is just $15. And yet, in the past 15 years, TB incidence rates have soared in the region - by fourfold in Malawi and fivefold in Kenya.

"Despite commendable efforts by countries and partners to control tuberculosis, impact on incidence has not been significant and the epidemic has now reached unprecedented proportions," said WHO Africa director Dr. Luis Gomes Sambo. "Urgent and extraordinary actions must be taken."

Source: Seattle Post- Intellingencer

Two diseases, one patient: Pilot TB/HIV care programmes in the region

This is a report from the 7th International Congress on AIDS in Asia and the Pacific (ICAAP), Kobe, Japan: 1-5 July 2005 by the HDN Key Correspondent Team

Four countries in the Asia Pacific region are piloting approaches to integrate HIV/AIDS and tuberculosis (TB) treatment, care and support services.

According to reports presented at the recent 7th ICAAP conference in Kobe, Japan, bringing together these two sets of activities at a country level is proving difficult. Because of the isolated and parallel nature of TB and HIV programmes, as well as the differences in practical approaches required to address the two diseases.

Cambodia, India, Indonesia and Thailand are among the countries that have carried out pilot initiatives to integrate TB and HIV in their existing systems, maximising existing resources in order to accommodate increasing numbers of people living with HIV/AIDS (PWHAs). The approach taken was holistic in the sense that community members other than those living were also encouraged to make use of the facility and get screened for tuberculosis.

The strategy and the circumstances under which countries should implement joint treatment programmes were recently recommended as part of an interim policy on collaborative TB/HIV treatment released by the World Health Organization (WHO).

Common to each of the pilot programmes in these four countries was the use of a voluntary counselling and testing (VCT) approach. Every person screened for TB is encouraged to get tested for HIV and vice versa. Diagnostic tests for TB are routinely offered procedures for all clients.

Under the new approach, HIV positive individuals are trained as TB educators together with other clients. Teaching materials are also made available. What interests people to avail of the TB services is the confidentiality of their identity, and the fact that they are allowed to view the tuberculosis bacteria under a microscope; allowing them to gain a deeper understanding that the bacteria is tiny and can be cured if antibiotics are taken as directed by the healthcare providers.

PWHAs are routinely put on TB prophylaxis, medicines that prevent the development of 'active' TB, while those who are diagnosed with TB are given treatment to cure the disease. Those clients exhibiting complications are referred to a government tertiary hospital. A referral system is put in place right from the start to ensure a continuum of care from the home to community and the hospital, including other social services.

Although complex at times, the pilot initiatives have shown that if TB and HIV are addressed together it can extend the lives of people living with HIV/AIDS. Clear national policies that would support TB and HIV programmes are required in order to sustain the initiative. Among other challenges is the absorptive capacity of the health providers, laboratory capacity and the quality of the laboratory procedures to maintain a higher level of services. Sustainable support for opportunistic infection medication and antiretroviral drugs, patient education and reasonable living conditions are also vital. Monitoring and evaluation are necessary in order the measure impact and aid the initiative by guiding its future directions and informing future adjustments to practical approaches.

TB is the number one killer of people living with HIV/AIDS. In Asia the countries with the highest incidence of TB are Cambodia, the Philippines and Indonesia and the majority of deaths among people with AIDS (PWHA) are tuberculosis-related.

Greater attention was given to the interaction between these parallel conditions when Nelson Mandela highlighted the issue during the 2004 International AIDS Conference held in Bangkok Thailand. He gave a personal testimonial of how tuberculosis had affected his health, his overall well being and part of his perspective on life.

***
HDN Key Correspondent Team
Email: correspondents@hdnet.org
(July 2005)

Source: SEA-AIDS eForum

Thailand To Offer TB Treatment As Part of HIV/AIDS Treatment Program

August 4, 2005, Kaiser Daily HIV/AIDS report

Thailand's Ministry of Public Health will offer tuberculosis treatment at no cost to the country's HIV-positive residents in an effort to reduce the number of people living with both diseases, Thailand's Nation reports. TB treatment will be included under Thailand's antiretroviral drug program that provides low-cost treatment to all HIV-positive people in the country (Nation, 8/3).

The health ministry announced last month that the country plans to provide low-cost antiretrovirals to the more than 500,000 HIV-positive people who live in the country. Thailand already provides antiretrovirals at no cost to about 50,000 low-income HIV-positive people under a pilot program that provides basic care to all Thai people. The expanded program makes Thailand the first country in the world to give all HIV-positive residents access to antiretrovirals, according to the health ministry (Kaiser Daily HIV/AIDS Report, 7/15).

Under the new treatment program, TB patients who test positive for HIV will be evaluated for antiretroviral treatment at no cost, and any HIV/AIDS patients who test positive for TB also will be enrolled in the TB treatment program. Approximately 55,000 people currently are enrolled in the treatment program, which lasts between six and eight months. "The more tuberculosis patients who are cured, the less chance there is that the disease will spread to the rest of the population," Deputy Public Health Minister Anutin Charnvirakul said. About one-third of the country's HIV-positive people have TB, which is about 12 times the rate of TB among HIV-negative people, Charnvirakul said (Nation, 8/3).

Source: Kaiser.org Daily Reports