Perspective: Greater Integration of TB-HIV programmes
By HDN Key Correspondent, October 2005
Tuberculosis (TB) and HIV co-infection is an important public health problem in South Africa and is being addressed through a national programme of collaborative TB and HIV activities. A national TB/HIV coordinating body has been established to oversee collaborative activities, which have so far initiated been implemented in 44 out of 174 sub-districts and is planned for expansion to cover the entire country by 2007.
TB/HIV provincial coordinators and national staff have been recruited and national guidelines for care of HIV-infected TB patients, including access to antiretroviral (ARV) therapy, have been developed. Voluntary counselling and testing (VCT) for HIV infection is also offered routinely to TB patients in some places, although the acceptance rate remains low.
A number of NGOs are involved in providing TB services and are also mobilising community-based support, but more needs to be done to also encourage broader private sector participation.
The two diseases form a deadly combination and many of the complications that bring TB patients to health clinics are associated with HIV. In 2002 up to 55% of TB patients in South Africa were reportedly HIV positive (Global TB Report 2005).
Despite the fact that the two diseases so often go hand in hand, South Africa is one of the few countries on the continent taking steps towards greater integration of HIV and TB treatments. It is a national policy, for example, that all TB patients should be counselled to test for HIV, and conversely that all those who test HIV positive should be screened for TB.
Concerned by the close association of TB and HIV, the Centre for the AIDS Programme of Research in South Africa (Caprisa), is pioneering an innovative approach to see whether TB and AIDS care can be integrated. The idea is to recruit patients for antiretroviral (ARV) therapy before their immune system is so weak that their recovery is difficult.
HIV affects the immune system and increases the likelihood of people acquiring new TB infection. Immune suppression also promotes both the progression of latent TB infection to active disease and relapse of the disease in previously treated patients.
People with HIV are up to 50 times more likely to develop active TB in a given year than HIV-negative people.TB accounts for up to 40% of deaths due to AIDS in Africa as well as in Asia. It is one of the leading causes of death in HIV-infected people and, without proper treatment, approximately 90% of those living with HIV die within months of contracting TB.
Following reports by the World Health Organization (WHO), which declared South Africa as having one of the worst TB epidemics in the world, TB laboratory testing services, to ensure that infectious TB patients are diagnosed efficiently, have been improved and greater efforts are being made to offer tests and/or treatments promptly.
Training 5000 health workers on the directly observed therapy (DOTS) strategy, has helped to ensure that all DOTS pilot districts have appropriately trained staff. The DOTS strategy is a health care management approach that seeks to ensure patient compliance/adherence by watching them swallow their TB drugs and ensuring that they complete their course of treatment.
Other components of DOTS include the appointment of TB managers, training of health staff and monitoring of the patients throughout the treatment process.The South Africa Department of Health says although it's strengthening its TB management services, the TB burden continues to grow because of the escalating HIV/AIDS epidemic, high percentages of patients who do not complete their TB treatment and the rising number of drug resistant TB cases.
The DOTS system has been criticised for 'policing' patients, rather than educating them to take responsibility for their own health, as is the case with the AIDS patients about to begin ARV treatment. Making use of counsellors trained to educate AIDS patients about the importance of drug adherence is another plan yet to make it off the drawing board in South Africa.
NGOs, such as the South African National TB Association (SANTBA) and the Western Cape TB Alliance, are powerful partners in the effort to fight TB in the community. Cooperation between the government and NGOs is essential in linking health service staff to patients, families and communities, and thus curing more TB patients.
As former South Africa President, Nelson Mandela said during the International AIDS Conference in 2004: "We can't fight AIDS unless we do much more to fight TB." That may be more true in his own country than anywhere.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
Tuberculosis (TB) and HIV co-infection is an important public health problem in South Africa and is being addressed through a national programme of collaborative TB and HIV activities. A national TB/HIV coordinating body has been established to oversee collaborative activities, which have so far initiated been implemented in 44 out of 174 sub-districts and is planned for expansion to cover the entire country by 2007.
TB/HIV provincial coordinators and national staff have been recruited and national guidelines for care of HIV-infected TB patients, including access to antiretroviral (ARV) therapy, have been developed. Voluntary counselling and testing (VCT) for HIV infection is also offered routinely to TB patients in some places, although the acceptance rate remains low.
A number of NGOs are involved in providing TB services and are also mobilising community-based support, but more needs to be done to also encourage broader private sector participation.
The two diseases form a deadly combination and many of the complications that bring TB patients to health clinics are associated with HIV. In 2002 up to 55% of TB patients in South Africa were reportedly HIV positive (Global TB Report 2005).
Despite the fact that the two diseases so often go hand in hand, South Africa is one of the few countries on the continent taking steps towards greater integration of HIV and TB treatments. It is a national policy, for example, that all TB patients should be counselled to test for HIV, and conversely that all those who test HIV positive should be screened for TB.
Concerned by the close association of TB and HIV, the Centre for the AIDS Programme of Research in South Africa (Caprisa), is pioneering an innovative approach to see whether TB and AIDS care can be integrated. The idea is to recruit patients for antiretroviral (ARV) therapy before their immune system is so weak that their recovery is difficult.
HIV affects the immune system and increases the likelihood of people acquiring new TB infection. Immune suppression also promotes both the progression of latent TB infection to active disease and relapse of the disease in previously treated patients.
People with HIV are up to 50 times more likely to develop active TB in a given year than HIV-negative people.TB accounts for up to 40% of deaths due to AIDS in Africa as well as in Asia. It is one of the leading causes of death in HIV-infected people and, without proper treatment, approximately 90% of those living with HIV die within months of contracting TB.
Following reports by the World Health Organization (WHO), which declared South Africa as having one of the worst TB epidemics in the world, TB laboratory testing services, to ensure that infectious TB patients are diagnosed efficiently, have been improved and greater efforts are being made to offer tests and/or treatments promptly.
Training 5000 health workers on the directly observed therapy (DOTS) strategy, has helped to ensure that all DOTS pilot districts have appropriately trained staff. The DOTS strategy is a health care management approach that seeks to ensure patient compliance/adherence by watching them swallow their TB drugs and ensuring that they complete their course of treatment.
Other components of DOTS include the appointment of TB managers, training of health staff and monitoring of the patients throughout the treatment process.The South Africa Department of Health says although it's strengthening its TB management services, the TB burden continues to grow because of the escalating HIV/AIDS epidemic, high percentages of patients who do not complete their TB treatment and the rising number of drug resistant TB cases.
The DOTS system has been criticised for 'policing' patients, rather than educating them to take responsibility for their own health, as is the case with the AIDS patients about to begin ARV treatment. Making use of counsellors trained to educate AIDS patients about the importance of drug adherence is another plan yet to make it off the drawing board in South Africa.
NGOs, such as the South African National TB Association (SANTBA) and the Western Cape TB Alliance, are powerful partners in the effort to fight TB in the community. Cooperation between the government and NGOs is essential in linking health service staff to patients, families and communities, and thus curing more TB patients.
As former South Africa President, Nelson Mandela said during the International AIDS Conference in 2004: "We can't fight AIDS unless we do much more to fight TB." That may be more true in his own country than anywhere.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
posted by AIDS-Care-Watch at 7:52 am
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