SWAZILAND: TB-HIV services needed to lower world's highest rates
MBABANE, 4 November 2009 (PlusNews) - Swaziland not only has the world's highest HIV prevalence rate, it now also has the highest tuberculosis (TB) rate, but health officials warn that not enough is being done to integrate TB and HIV services.
Last week the Ministry of Health and Médecins Sans Frontières (MSF), the international medical humanitarian organization, brought together health experts to look at practical solutions for the small landlocked country.
One in four adults is infected with HIV; by the end of 2007 an estimated 170,000 people were living with HIV, and every year an estimated 13,000 people develop TB, the primary opportunistic disease in HIV-positive people.
"When you look at the history of TB in Southern Africa you see that it was considered a very serious disease in the 1950s, but seemed to be under control by the 1980s; but with the arrival of HIV and AIDS, TB rates have really gone out of control," said Prof Alan Whiteside, head of the Health Economics and HIV Research Division (HEARD) at the University of KwaZulu-Natal in South Africa.
Themba Dlamini, manager of Swaziland's National TB Control Programme, said 80 percent of Swaziland's TB cases were also HIV-positive.
But with governments focused on HIV/AIDS, TB has not been getting enough attention.
"Part of the problem is we've been very good at mobilizing for HIV and AIDS, and we sort of forgot about TB as we did that. Unfortunately, I don't think the people mobilizing for TB have been as articulate and as powerful as those mobilizing for HIV and AIDS - we need to put TB higher on the public agenda," Whiteside told IRIN/PlusNews.
Swaziland's Health Minister, Benedict Xaba, reminded delegates that although the country provided free TB medicines, other costs, such as hospital fees and transport, made it difficult for many people to access health services.
"There are several issues that Swaziland needs to face. Access to care is particularly important ... so people who show signs of symptoms can be checked immediately. Free consultation is absolutely imperative - we must think of free care from diagnosis to clinical cure," urged Dr Mario Raviglione, Director of the Stop TB Department of the World Health Organization (WHO).
Raviglione urged the country to step up efforts to integrate TB and HIV services. "It doesn't make any sense for a person taking TB drugs and ARVs [antiretrovirals, to treat HIV] to go to two separate doctors. These must be integrated."
About 58 percent of TB patients completed their six-month course of treatment last year, falling far short of the 85 percent target recommended by WHO. International guidelines also set a 70 percent detection target for TB, but in Swaziland the case detection rate is below 60 percent.
The good news is that, unlike HIV/AIDS, TB is curable. "I know people living with HIV and TB, and their TB has been dealt with," noted Whiteside. "It is a community message we need to get out - that we are capable of eliminating the scourge of TB in your community."
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