Pointing to mounting evidence of the impact of tuberculosis on the health of pregnant women and their children, the President’s Emergency Plan For AIDS Relief is recommending improvements to efforts to detect the disease in settings offering health services to pregnant women, women with HIV, newborns, and children.
“Recent studies have shown that HIV-infected pregnant women are at increased risk of transmitting both TB and HIV to their infants,” the PMTCT/Pediatric HIV Technical Working Group Recommendations for Integration of Tuberculosis Screening into PMTCT/Pediatric HIV Programs points out. Still, it says, “despite international guidelines,” intensified screening recommended for people living with HIV have not made it into most settings working with pregnant HIV-infected women.
The working group recommends:
- Infants and children living with HIV should routinely be screened for TB as a part of standard clinical care. HIV-infected children who are older than 12 months of age and are not found to have active TB should be given IPT for 6 months, in accordance with WHO guidelines.
- Regardless of HIV status, infants who are born to mothers with TB disease or who have a history of contact with a TB case should be evaluated for TB disease. If active TB is not identified, the infant should be given IPT for 6 months in accordance with international guidelines. In addition, given the difficulty of identifying TB disease in children, the infant should be continuously monitored for the development of signs and symptoms of active TB disease. Linkages and referral mechanisms should be established between HIV and TB programs to ensure that pregnant women and infants identified as persons with possible TB are properly evaluated for TB and those found to have TB disease receive appropriate anti-TB treatment and follow-up per national policy/international guidelines.
- Mechanisms should be put in place to document, monitor, and evaluate TB screening, diagnostic, and treatment activities as well as outcomes among pregnant women and children.
- TB infection control activities should be implemented in PMTCT settings in accordance with international guidelines.
Tuberculosis continues to be the leading cause of death among people living with HIV, and had made nearly 10 million children orphans as of 2009, the group points out.