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 Tuesday 30 October 2007
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AFRICA: Better integration needed in fight against linked HIV and TB infection

Photo: Siegfried/IRIN
TB patients at the Blue House Clinic, Nairobi, Kenya
KIGALI, 20 June 2007 (PlusNews) - An HIV-positive patient with tuberculosis (TB) can find that, in Africa, obtaining care and treatment for both conditions is often a slow and frustrating experience, necessitating constant shuttling between doctors and clinics.

TB, an airborne infection, is the leading cause of death among HIV-positive people, whose weakened immune systems are 50 times more likely to develop active TB.

But there has been little collaboration between health care professionals working on the twin diseases.

In 2005, only seven percent of all TB patients were tested for HIV, while less than 0.5 percent of people living with the virus were screened for TB, according to Alasdair Reid, TB/HIV adviser for UNAIDS.

The emergence of extremely drug-resistant TB was a dramatic wake-up call for health officials, and "integration" has become the latest buzzword.

So how feasible is it? Officials from the World Health Organisation's (WHO) Stop TB programme, who attended a 2007 HIV Implementers Meeting this week, in Kigali, Rwanda, acknowledged that integrating TB and HIV care would be a major challenge to developing countries with inadequate health systems.

WHO has issued an interim policy on TB/HIV collaborative activities - a 12-step guide for healthcare facilities - and made repeated calls during the conference for more countries to begin the integration process.

"TB and HIV programmes should work together at all levels ... it is time to scale up these collaborative activities nationwide," WHO's Dr Tergest Gerema told delegates to the meeting during a discussion of lessons learnt on scaling up AIDS services.

A marriage that must work

There are some signs of progress. Dr Hellen Muttai, clinical care manager of the South Rift Valley HIV Care and Treatment programme in Kenya, said her centre had been a one-stop integrated TB/HV clinic since 2005, offering TB diagnosis and treatment; HIV testing and counselling; and TB and HIV care and treatment for coinfected patients.

The clinic, run by the Walter Reed Project, a US army medical research institution, has had 94.2 percent of its TB patients tested for HIV; all coinfected patients have begun antiretroviral (ARV) treatment, which can prolong the lives of those living with the HI virus.

But Muttai noted that doctors specialising in TB lacked confidence in dealing with coinfected patients, preferring to refer them to an HIV specialist, which often resulted in patients falling through the cracks.

"Integration is a fairly new concept and countries are struggling to increase the uptake of collaborative services," she admitted.

A Kenyan delegate told IRIN/PlusNews that in his country, which was among those hardest hit by both epidemics, TB and HIV/AIDS collaboration was a "marriage that must work".

''HIV/TB linkages are being addressed at a clinical level, but what is happening at community level? We need to go to communities, rather than work from hospitals''
In 2004, Kenya's health ministry issued a policy document on testing for HIV in clinical settings, which contained a bold statement: clinicians who failed to test people presenting with HIV for illnesses associated with the virus would be deemed to have provided substandard care.

"This was a landmark event ... it made a lot of difference and paved the way" for greater collaboration in TB and HIV activities, Dr Chukaya Muhwa, former national TB programme manager in Kenya, said at the conference.

An exponential growth in funds dedicated to HIV/AIDS followed, largely provided by funding mechanisms such as the US President's Emergency Plan for AIDS Relief, and the Global Fund to Fight Tuberculosis, HIV/AIDS and Malaria.

Then the real work began. Staff shortages in the healthcare system was one of the major challenges; a survey found that an additional 190 doctors and 1,700 nurses were needed for the programme, and the available staff were "highly demotivated", Muhwa said.

Planning and coordination efforts were strengthened, although Muhwa noted that more needed to be done, especially on an effective monitoring and evaluation system of TB and HIV programmes.

Despite good progress in having TB patients tested for HIV, "we have not done well to decrease the burden of TB in people living with HIV/AIDS", he admitted. The provision of ARVs to coinfected patients was also still inadequate.

According to Muhwa, implementing the strategy was an uphill battle in many African countries. "HIV/TB linkages are being addressed at a clinical level, but what is happening at community level? We need to go to communities, rather than work from hospitals," a delegate remarked.

Community health workers trained to offer the Directly Observed Short-Course Treatment (DOTS) for TB, which monitors patients while they take their medication, would need to be trained to support HIV patients, who received intensive counselling on adherence before they started taking ARVs, delegates heard.

Communities were a "crucial partner", said Reid of UNAIDS, and there was a need to engage them in implementing and monitoring TB/HIV activities. He warned delegates that "many opportunities to provide better care and avoid unnecessary deaths are being missed".


Theme(s): (IRIN) Care/Treatment - PlusNews, (IRIN) HIV/AIDS (PlusNews), (IRIN) PWAs/ASOs - PlusNews, (IRIN) Research - PlusNews


[This report does not necessarily reflect the views of the United Nations]
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