2010 has been the year of the lung and tremendous efforts have gone into detecting and managing TB cases both in health institutions and at the community level.
TB is the most common cause of death among people living with HIV. In 2008, there were an estimated 1.4 million HIV positive TB patients globally and half a million people who died of HIV-associated TB.
TB is treatable
The World Health Organisation (WHO) recommends three key interventions to reduce the burden of TB in people living with HIV. TB infection control measures such as ensuring well ventilated environments and cough etiquette, isoniazid preventative therapy, and intensified case finding, which involves referrals from HIV to TB care and vice versa.
To manage HIV/TB co-infected patients effectively in a health clinic requires ventilated rooms and separate TB wards and the clear demarcation of out-patients rooms to reduce the spread of TB from an infectious person.
For many communities with poor healthcare facilities, accessing adequate integrated HIV/TB services remains a challenge but there is an opportunity for communities to play a vital watchdog role. This could include promoting adherence through peer and community based support groups and engaging with HIV and TB service providers to ensure that integrated services are scaled up.
Managing TB/HIV in primary healthcare
Last month a small group of Alliance colleagues from the UK, China and India visited an HIV/AIDS community care centre in the Khurda District in Orissa, India. The centre, named ASTHA (meaning ‘trust’ in Hindi) is run by a local NGO, the Medics in Bhubaneswar City, a partner of Lepra, funded by the Global Fund against HIV/AIDS, TB and Malaria.
Since June 2008 the 10 bed centre has provided medical services for over 600 people living with HIV starting antiretroviral therapy (ART). The clinic’s medical services consist of counselling, diagnosis and treatment of sexually transmitted infections and opportunistic infections, ART adherence, positive prevention and referrals to other health services such as family planning.
Renato Pinto senior advisor in the technical cooperation unit at the Alliance was among those who visited. “ASTHA is well-managed, spacious and clean and the staff are well versed in HIV/TB co-infection issues but they still face the challenge of ensuring that infection standards are in place, such as providing well ventilated rooms and separate wards for patients with active TB in order to control opportunistic infections that are often part of the early days of any anti-retroviral therapy,” he said.
Of the 617 people treated up until July 2010 there have been 50 reported cases of patients with HIV/TB co-infection. All individuals affected by TB are carefully treated and when discharged they are referred to local service providers for DOTS treatment, which follows a standardized multi-drug treatment and thorough follow up.
Renato adds, “community care approaches should be prioritised to reduce or avoid hospitalisation and the number of outpatient visits. In resource-limited setting where infection control is often poor, community involvement is essential in reducing social, economic and health burdens of infectious diseases. This can include providing treatment literacy in TB and DOTS, and referral systems and infection control measures in community and home-based care facilities.”
Strengthen partnerships to tackle TB
Strengthening TB knowledge and partnerships with national TB programmes and other TB organisations are essential.
In Kenya, Alliance linking organisation KANCO have been advocating for better links between HIV and TB. They have produced new HIV/TB guidelines and appointed a staff member to focus on improving their response to this issue. They are also advocating for nationally produced guidelines on HIV/TB integrated care.
The challenge in Kenya of co-managing TB and HIV is that although 90 per cent of TB patients are counselled and tested for HIV, the majority are not routinely screened for TB. KANCO have found one way of educating the community is to train TB patients as advocates so they are able to intervene earlier by supporting newly diagnosed patients to reduce the emergence of multi-drug resistant TB. To date, KANCO have trained 260 former and current TB patients to be advocates.
“It’s really important that we continue to promote and increase the integration of the response to HIV/TB co-infection by providing information and strengthening community organisations to provide care,” said Renato.
Read more about Alliance’s work on TB and HIV.
Community involvement is essential in reducing social, economic and health burdens of infectious diseases.