HIV, TB Treatment Needs To Be Better Integrated In Africa
Officials at the 2007 HIV Implementers' Meeting in Kigali, Rwanda, recently discussed the need for health care workers to integrate HIV and tuberculosis care in Africa, where "obtaining care and treatment for both conditions is often a slow and frustrating experience," PlusNews reports. About 7% of all people with TB were tested for HIV in 2005, and less than 0.5% of people living with HIV were screened for TB during the same time period, according to Alasdair Reid, a TB/HIV adviser for UNAIDS.
To address the situation, the World Health Organization has called on countries to begin integrating HIV and TB programs and issued an interim policy on collaborative activities, which includes a 12-step guide for health care facilities. Officials from WHO's Stop TB Department at the conference said that integrating TB and HIV programs is a significant challenge for developing countries with inadequate health infrastructures. Tergest Gerema of WHO said, "TB and HIV programs should work together at all levels ... it is time to scale up these collaborative activities nationwide."
Some countries are showing signs of progress. Hellen Muttai, clinical care manager of the South Rift Valley HIV Care and Treatment program in Kenya, said the center since 2005 has offered TB diagnosis and treatment along with HIV testing, counseling and treatment. The clinic, which is run by the Walter Reed Project, reports that it has tested 94.2% of people with TB for HIV and that all people diagnosed with both HIV and TB have started antiretroviral treatment, PlusNews reports.
Muttai said doctors who specialize in TB sometimes lack confidence to treat people with HIV/TB coinfection and thus often refer them to an HIV specialist. "Integration is a fairly new concept, and countries are struggling to increase the uptake of collaborative services," Muttai said. Kenya's Ministry of Health in 2004 issued a policy stating that if clinicians fail to test HIV-positive people for illnesses associated with the virus, care they deliver would be deemed substandard. Chukaya Muhwa, a former national TB program manager in Kenya, described this as a "landmark event" that "made a lot of difference and paved the way" for increased collaboration between TB and HIV programs.
Integration efforts faced some challenges, including staff shortages and "highly demotivated" staff, according to Muhwa, who said that many African countries face similar issues when attempting to increase collaboration between HIV and TB programs.
Officials at the conference said DOTS workers need to be trained to support people with HIV. Reid said communities are a "crucial partner" in such efforts and should be engaged to implement and monitor TB/HIV coinfection. He said that "many opportunities to provide better care and avoid unnecessary deaths are being missed" (PlusNews, 6/20).
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