THIS week, because of the overwhelming calls I received following a recent article on TB, I went to google to check a few tips on TB and HIV/AIDS and found the following article:
Treatment of latent TB infection with Isoniazid has been found to be highly effective in preventing the progression from latent to active TB disease in HIV co-infected people.
Preventing HIV in people with TB, The World Health Organisation recommends that a number of HIV related
prevention services should be provided for people with TB by either TB programmes or by referral to HIV/AIDS programmes. Such services should include amongst other things, counseling, social support and the prevention and treatment of sexually transmitted infections.
Integrating TB and HIV services
For many years TB and HIV programmes at worldwide, national and local levels have operated separately, with separate management and funding streams and with little coordination. As a result patients with HIV and TB have had to access different services for screening, testing, care, treatment and adherence support.
Many people have called for the integration of services, claiming that it would provide benefits for patients, health care providers and health systems, and that the continuing vertical response to the TB and HIV epidemics is ineffective and inefficient. However, other people claim that there are cultural differences between the services which make integration in practice extremely difficult.
“The different histories and cultures of the TB and HIV communities raise many challenges in achieving an effective and productive partnership … TB services are geared towards chronic care services with simple and standardized technical procedures, while HIV/AIDS services are clinically oriented and tend to be more individual patient oriented.”
There are also differences between TB and HIV as diseases, which have influenced the way that services have developed. HIV is an incurable disease for which lifelong medication is required. HIV positive people will often attend HIV services for many years, building up a sometimes close relationship between health professional and patient.
HIV is not transmitted through casual contact with someone else with HIV, and HIV patients will often form themselves into self help groups, which include advocating for better services.
By contrast TB is a curable disease, and within two years of
developing symptoms most people who are able to obtain treatment for their active TB will be cured. So TB patients will usually not have such a long term relationship with the health professionals who provide their treatment. In addition, as patients with active TB who are not on effective treatment, can pass on the disease to others, there is not the same tendency for people with active TB to form self-help groups.
The different means of transmission are another reason why total integration of services is extremely difficult. People with active TB, who could pass on TB to people with HIV, should not be encouraged to come to the same part of a building at the same time as people with HIV, because of the risk of transmission.
Global policy on HIV and TB services
Although complete integration of HIV and TB services may be difficult, it is clear that a greater awareness of the problem of TB for people with HIV, and closer collaboration between services has already resulted in significant benefits.
In 2012 the World Health Organisation (WHO) claimed that 900,000 lives had already been saved over six years by protecting people living with HIV from TB.
The WHO HIV/TB policy includes:
•    The provision of antiretroviral therapy for all HIV positive TB patients, regardless of their CD4 count.
•    Provision of co-trimoxazole to provide TB patients with HIV with protection against lung and other infections.
In addition it is recommended that there should be surveillance of HIV and TB amongst health care workers, and that health care workers who are HIV positive, should be moved from areas with high TB exposure. The stigmas of TB and HIV/AIDS The stigmas of HIV and TB have come full circle.
In the early days of the HIV/AIDS epidemic, people were said to have died of TB when they had actually died of AIDS.
• We all died
• Coughed and died
• We died of TB
• That was us
• Whispering it at funerals
• Because nobody ever said AIDS
Now in the townships of South Africa, people will enter the shack (township home) of someone with HIV, but they will stop at the door if the person has XDR TB. (I am sure I will still bring something more on TB and HIV/AIDS in the near future).
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