Maputo, Mozambique – The regional meeting to scale up collaborative TB/HIV activities in Africa kicked off in Maputo last week with presentations scheduled for 14 African country representatives to share progress and challenges in confronting TB/HIV co-infection in the most highly impacted region of the world.
Less half of HIV-infected individuals being treated for TB are on antiretroviral treatment for their HIV, a quarter of HIV-related deaths result from TB, and 30 percent of all deaths from TB are among HIV-infected people, Diane Havlir, Chair of the TB/HIV Core Group of the WHO STOP TB Partnership reminded, in the morning session.
Provision of early antiretroviral treatment to individuals co-infected with HIV and TB was the focus of the session. While research and development have brought proof that antiretroviral therapy packs a powerful punch in preventing HIV-infected persons from getting TB, and that early antiretroviral treatment significantly reduces deaths from TB when disease occur, access to antiretroviral treatment for HIV-infected people with or without TB falls far short of universal in most countries. Since 2011, World Health Organization guidelines have called for immediate access to antiretroviral treatment for persons co-infected with TB and HIV but many countries did not immediately change their own guidelines. Even those most highly affected countries that have embraced a commitment to 100 percent antiretroviral treatment coverage for TB patients, only two countries have done better than 65 percent coverage—Kenya and Zimbabwe — according the WHO TB/HIV Coordinator, Dr. Haileyesus Getahun. In most countries, the percentage of the general HIV population on antiretroviral treatment is far higher than the percentage of co-infected individuals receiving the treatment, Getahun noted.
Snapshot from Tanzania
Later in the morning, a Tanzania Ministry of Health official discussed her country’s effort to meet the challenge of TB/HIV co-infection in a nation of 44 million people where HIV prevalence is a little more than 5 percent, and 38 percent of TB patients live with HIV.
Limited decentralization of HIV care and treatment is a major barrier to treating one patient with two diseases, she said, and capturing initiation of antiretroviral treatment in TB patients beyond the 3-month reporting period remains a challenge. Providers can be hesitant to treat both conditions at the same time and patients may resist HIV treatment because of fear, the pill burden and additional stigma associated with HIV infection. As a consequence of these and other factors, Tanzania has a high HIV testing acceptance rate but low uptake of antiretroviral treatment among TB/HIV co-infected patients.
After piloting a program offering HIV care and treatment in one TB clinic and in one site, the Ministry of Health piloted a program and after evaluating the pilot, found that uptake of antiretroviral treatment increased to 81 percent.
In response to these results, Tanzania has moved to integrate HIV services into 70 TB clinics across the country, selecting and renovating sites based on a high TB/HIV burden. TB staff members have been trained on HIV management, TB/HIV coordinators have been introduced at the national and district levels, and efforts are underway to decentralize HIV care and treatment services to primary health facilities.