Special Edition eCorrespondent - June 2008 - Issue 14  Jointly produced by: Health & Development Networks (HDN) and AIDS Care Watch campaign
 
 
 
 
Bold new leadership is needed to galvanize action on the HIV/TB epidemic. 




 
USD 40 billion is the funding gap for the Global Plan to Stop TB (2006-2015) - hope the leaders are listening! 











 
'One Life - Two Diseases - One Response'
 
 
TB and HIV leaders are talking, but are they listening?
 
 

Last Monday, the First TB/HIV Global Leaders' Forum took place inNew York. Belated timing aside, this is a significant step towards making an impact on co-infection of HIV and TB. 

On the ground, health care workers know that collaboration is essential in the care of HIV/TB patients, yet in may instances the resources and programme structures they rely on are letting them down.

Resources that are allocated to one disease or the other create tension and discourage collaboration. Additionally, they encourage programmes to become inherently self-absorbed and self-interested.

Effective health systems, capable of delivering comprehensive care for TB and HIV, are lacking in the worst affected countries. Limiting the single-issue projects and programmes, and maximizing the efficiency of health systems in their entirety would be a significant first few steps towards tackling the TB and HIV co-infection.

Leaders need to put aside their vested interests and listen to the patients and doctors with first-hand experience of the two diseases. They hold the key to overcoming the deadly combination. Many see this as just another meeting. Let us hope instead that combining forces results in radical action.

A call for action from the 9 June Forum is 'a living document' according to Dr Jorge Sampio, UN Secretary General's Special Envoy to Stop TB,  which should guide countries in reducing the numbers of death from TB and HIV co-infection. A report on progress will be made at the Stop TB Partnership's Partners' Forum, to be held in March 2009 in Rio de Janeiro, Brazil. Time will tell and history will judge whether leaders were listening on June 9.

 
 
 
 
 
 

For the past few weeks, members have added their thoughts and experiences to the debate on how best to approach TB/HIV co-infection. Involving communities through education and self-help groups, and  extending community based treatments to all those with HIV were among the inventive practical solutions posted. The need for better management in diagnosing and treating TB/HIV patients was widely agreed upon. This included the question of whether ARVs or anti-TB treatment was the priority.

 

The issues surorunding social support, stigmatisation and resources in TB/HIV were also addressed on the Stop-TB eForum. These are all points that leaders who met at the First HIV TB Global Leaders' Forum will have to ensure are integrated into their strategy for tackling co-infection. To ignore any of the medical or social subtleties is to risk failure.

 
 
 

Although HIV and TB co-exist in one patient, many are managed by two different teams of healthcare workers. The extent to which they collaborate varies, as does the effort made by either side. Do TB doctors offer advice more frequently than they listen to not only HIV doctors but also people living with HIV and TB co-infection, for instance? Creating a multidisciplinary service will take time but is not impossible, as shown in this post fromPeru. The medical details need careful consideration and will enhance the skills of health workers from both fields.

 

Children with HIV are vulnerable to drug-susceptible TB, multi-drug resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB) infection. Whether should they be placed in wards where they risk nosocomial transmission, was actively debated on the Stop-TB eForum. What can parents and health workers do to prevent this? Members suggestions were informative and practical.

 
 
TB/HIV facts
250,000
 
people died with HIV associated with TB in 2006
 
90
 
per cent or higher is the case-fatality rate in people living with HIV who contract extensively drug-resistant TB (XDR-TB)
 
1
 
per cent or less people living with HIV were screened for TB in 2006
 
0.08
 
per cent of people living with HIV were put on isoniazid preventive therapy (IPT) in 2006 which prevents active TB
 
 
 

"We cannot separate the fight against HIV/AIDS from the fight against TB"

 
— UN General Assembly President Srgjan Kerim, who presided over a two-day high-level meeting on AIDS (10-11 June 2008)
 
 
 

Health workers might accept the modest risk of becoming HIV-infected through needles and blood. But, "it is quite another thing if you are at risk by sharing air with patients with HIV disease" who have tuberculosis that is resistant to standard and second-line drugs. This "has the potential to change how health care workers look at the issue of AIDS care."

 
— Dr. Kevin M DeCock, Director, HIV/AIDS department, WHO
 
 
 
9 June
Call for Action endorsed at the First HIV TB Global Leader's Forum, New York, USA
 
19-22 June
13th International Congress on Infectious Diseases, Kuala Lumpur, Malaysia
 
30 June
International Clinical and Operative Handling of drug-resistant TB, Mexico