SOURCE: AF-AIDS is the regional forum on HIV/AIDS in Africa, coordinated by the Health & Development Networks Moderation Team (HDN, www.hdnet.org) with technical support from Health Systems Trust (HST) on behalf of the AF-AIDS Steering Committee (HST, HDN & SAfAIDS), with the support of the Government of Ireland. Reproduction welcomed provided source is cited as follows: AF-AIDS eForum 2003: af-aids@healthdev.net TB and HIV programmes prepared to merge at long last By HDN Key Correspondent 13th ICASA, Nairobi, Kenya, 22 September 2003 ************************* HIV-associated illnesses are creating a six percent annual increase in the number of tuberculosis (TB) cases across sub-Saharan Africa. According to new joint programme planners, the TB/HIV co-epidemics will only be effectively addressed by an integrated interventions for early detection and treatment of both diseases. A new policy document just released by the World Health Organisation (WHO) provides national governments and TB/HIV programme managers with immediate and crucial guidance on how this can be achieved under particular circumstances. The new policy framework is intended to promote enhanced collaboration between programmes in individual countries and the provision of a continuum of quality service delivery. According to WHO, tuberculosis is the leading cause of death among people with HIV infection, accounting for one third of deaths due to AIDS worldwide. An estimated one third of the 42 million people living with HIV worldwide are co-infected with tuberculosis. Approximately 90% of people living with HIV die within a few months of becoming sick with TB if they do not receive adequate TB treatment. Of those co-infected with HIV and TB, well over half (70%) live in sub-Saharan Africa. WHO also recently called for free anti-TB drugs (ATDs) and quality care to be made widely available to people living with HIV, along with renewed efforts to increase access to anti-retrovirals (ARVs) in developing countries. ATDs are a cocktail of medicines comsisting of isoniazid, rifampicin, pyrazinamide and ethambutol that, when taken properly, are more than 95% effective in curing tuberculosis regardless of a person's HIV status. ATDs cost only $10 per patient for the entire course of treatment. Dr Mario Raviglione, acting director of WHO's Stop TB Department, regretted that "Ten years after an unprecedented declaration of a global TB emergency, the epidemic has grown even worse, primarily due to the spread of HIV. We need to increase our efforts to address the deadly synergy between the two diseases, each of which is fuelling the other's impact." As early as 1998, a so-called 'ProTEST' initiative was also developed by WHO, in response to the unprecedented scale of the epidemic of HIV-related TB. Its aim was to develop, through an operational research approach, a district-level strategy for a joint TB/HIV programmes. ProTEST focused mainly on the promotion of HIV voluntary counselling and testing (VCT) as an entry point into a broad package of care services aimed at reducing the dual burden of TB and HIV. This included the provision of HIV VCT in TB treatment facilities for example. In sub-Saharan Africa, ProTEST was first introduced in South Africa, Malawi and Zambia in 1998. ProTEST initiatives have been implemented in Ethiopia, Kenya, Mozambique, Tanzania and Uganda since 2002. The findings from a ProTEST 'lessons learned' workshop held recently in Durban, South Africa, were that collaboration between TB and HIV/AIDS programmes was feasible and helped to improve general health services delivery through the more efficient use of resources. The workshop heard that progress was limited however, mainly by constraints of human resources and absorption capacity. A Nairobi satellite symposium was held on Sunday entitled: "TB/HIV epidemic: how should TB and HIV/AIDS programmes respond?" During this Symposium, several speakers outlined the key issues and a panel discussion on 'accelerating collaborative TB/HIV activities' focused on immediate plans in sub-Saharan Africa. Key issues raised included the use of diagnostic HIV testing as the entry to accessing care, treatment, support and integral to the success of this joint strategy. Clearly, this posed challenges around the current Voluntary Counselling and testing programme in terms of confidentiality and ethical issues. Lessons from the TB control programme in terms of diagnostic skills, monitoring and evaluation should be considered. Joint advocacy, resource mobilisation, collaboration and co-operation are needed between the current TB and HIV programmes. A new programme should not be created. The phrase "Two diseases, one patient, one community" coined at the Third meeting of the Global TB/HIV working group was reiterated and a further dimension was added, that of there being only one health worker to ensure the delivery and success of the strategy. Adequate staffing to provide integrated care in already overloaded primary health care setting should be addressed as a matter of urgency. "More work cannot be expected without more resources", said Dr Paul Nunn of the WHO's Stop TB Division. Failure to do this will compromise quality and result in the inevitable failure of this joint strategy. **************** HDN Key Correspondent Team To contact the HDN KC team during ICASA or to comment on the Conference coverage: info@hdnet.org = = = = = = = = = = = = = = = = AF-AIDS is supporting the 13th ICASA in Nairobi, Kenya (Sept 21-26 2003) http://www.icasanairobi2003.org/ = = = = = = = = = = = = = = = =