A Lancet special series developed by an international team and led by Dr. Salmaan Keshavjee of Harvard Medical School’s Department of Global Health and Social Medicine lays out proven elements of tuberculosis control and how they can be worked into comprehensive approaches in high-risk, low-resource settings. And, at the same time the latest antiretroviral treatment guideline release serves up a reminder of another tried and true measure that can protect people with HIV from tuberculosis.
Data for action – Effective tuberculosis responses are local, but data to guide them is frequently not. This article calls for better use of existing data, and improved efforts to gather data that will help monitor the effectiveness of responses and identify challenges.
Turning off the tap – Finding people who are sick with tuberculosis, rather than waiting for them to seek treatment can speed diagnosis and treatment and limit exposure, but too often the most high prevalence settings rely on passive rather than active case finding, this article says. It examines successful approaches to screening and diagnosing TB among high-risk groups, which it notes, in all settings includes patients’ contacts.
Controlling the seedbeds – Of the billions of people worldwide infected with tuberculosis, not all need to, or can, receive preventive treatment, but those at the greatest risks of becoming sick should. This article explores how to find and prevent illness in those who, without intervention are most likely to get sick, interrupting chains of transmission in the process.
A biosocial model – While technologies to diagnose TB and medicines to treat the disease are essential, the disease itself is fueled by exclusions and inequities that undermine nutrition, housing, and access to healthcare, says this article. It makes the case for a biosocial approach integrating medical and structural responses.
With EACS release, all international HIV treatment guidelines agree on when to start — for the first time since 2006 – Early access to antiretroviral treatment for people with HIV is another way to stem the tide and toll of tuberculosis. Finally, with the release last week of the European AIDS Clinical Society HIV, all international recommendations align for the first time in nine years, this article by Gus Cairns of AIDSMap says. In 2006, all guidelines agreed that waiting until CD4 immune cell counts had dropped to a level that leaves people vulnerable to serious illnesses was acceptable. Now, following the results of the Temprano and START trials, which showed, among other findings that early treatment averts illnesses that include tuberculosis and death, they all agree that treatment upon diagnosis is better for patients and public health.