A TB/HIV doctor's anguish

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One hot-button – but little covered – issue around AIDS is HIV/TB co-infection. In March, the World Health Organization released a report estimating one out of every four TB deaths is HIV related, or twice as many as previously believed. The report estimated 456,000 deaths of people infected with both TB and HIV.

Today, the chilling threat of HIV/TB co-infection hit home to people around the world who had heard the stories – and voice — of South African health activist Thembi Ngubane, 24, in her radio diaries of her struggle against the AIDS virus. She died earlier this week, and today her family held a memorial service.

The urgency to do something about HIV/TB co-infection also unfolded here at the HIV/AIDS Implementers’ Meeting in a session that had drama as well – a South African HIV and TB doctor pleading that policymakers around the world do much more to fight the growing threat. (Next week, a US Senate committee is expected to be marking up the US foreign operations bill, which includes almost all global TB and HIV funding.)

“We have a public health catastrophe in Southern Africa that doesn’t seem to mobilize governments in any way that I can see,’’ said Dr. Francois Venter, head of the South African HIV Clinicians Society. “How long does it take for an emergency situation to become an emergency in this world?’’

Many TB experts, including those at the WHO and Centers for Disease Control and Prevention, are now pushing a strategy called the “Three Is’’ – which stands for isoniazid preventive therapy, intensified case finding for active TB, and infection control for TB.

But Venter said that in South Africa, the Three Is are not being implemented. He said that South Africa’s TB system was so poorly run it couldn’t possibly start the isoniazid single-dose treatment for those suspected of being in contact with TB, or improve conditions in hospitals or clinics to lessen the risk of TB infecting others, or find patients who no longer come back for their daily TB regimens

He said that half of all patients diagnosed with TB at Johannesburg’s Chris Hani Baragwanath Hospital – the largest hospital in the world — don’t make it to a TB clinic.

“This problem is not going to be solved with the best drugs in the world,’’ he said. “The system is failing these patients.’’

Others in the session cautioned that South Africa’s TB program – it spends more than 65 percent of its budget on multidrug-resistant TB cases, an abnormally high amount suggesting poor initial treatment of straightforward TB cases – was not representative of TB programs around the world. Many said the South Africa program was among the worst.

Venter didn’t disagree. At one moment, he seemed beside himself.

“You know we had 30 nurses die in one year from MDR-TB (multidrug-resistant TB) in a hospital north of Tugela Ferry ,” he said, referring to the site of the first reported outbreak of extensively drug-resistant TB, or XDR-TB, in which 52 of the first 53 patients died. “Nobody heard about it. It all went quiet. If I was a nurse I would refuse to work anywhere near a TB ward (in South Africa). That would be a rational response.’’

3 thoughts on “A TB/HIV doctor's anguish

  1. Juliet

    This is a very interesting site. I like to see the worls talk about real isues like this. Thanks to my friend Tara who fowarded this me.

    At least South Africa still has its health infrastructure intact. I do have a lot of relatives and friends in Zimbabwe, who have gone to SA just so they could access treatment. When they felt strong enough they went back home without any drugs where they know there is nothing for them to stay alive.

    Fortunately for humanitarian medical agencies such as MSF and others, some of my relatives and friends have been able to stay alive… But when their CD4 level increases to a certain level they stop providing you with medication..my siter told me that she was told her CD4 level is fine but she has all these OIs that will kill her and she is not on medication. None of my friends and relatives have accesed mediaction at a government run hosptal… because they do not meet the criteria for starting ARVs this so ridiculous!!

    So I count myself as the lucky one living in a developed country where I can change my medications if I do not like the side effects just like that even though my CD4 count is above 700 and VL non detectable I can still access medication where I can screen for TB every year without waiting to fall sick

    My faith in African governments serving their sick well is very low. Why doesn’t the PEPFAR and the Global Funds only serve credible medical humanitarians agencies who work in the remotest parts of developed countries. This way a lot of lives can be served.


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