[afro-nets] Combining TB Treatment with HIV Testing and Treatment

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Combining TB Treatment with HIV Testing and Treatment Could Save
Lives of up To 500 000 HIV-Positive Africans Every Year
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Joint UNAIDS WHO Press Release

Joint call for action follows Mandela's plea at Bangkok Interna-
tional AIDS Conference to strengthen fight against tuberculosis

Addis Ababa, Ethiopia, 21 September 2004 ­ Expanding access to
tuberculosis treatment, combined with introducing HIV testing
and anti-retroviral (ARV) delivery into TB programmes, could
save the lives of as many as 500 000 Africans living with HIV
every year and is one of the most cost-effective ways to ensure
the survival of HIV-positive people, according to international
health experts meeting this week in Addis Ababa, Ethiopia.

Joint TB and HIV interventions are among the best ways to accel-
erate access to ARVs and to help reach the "3 by 5" target of 3
million people on HIV treatment by the end of 2005, according to
WHO and UNAIDS. "If we jointly tackle TB and HIV, we can be much
more effective in controlling both diseases," said Dr Peter
Piot, UNAIDS Executive Director.

Of the estimated 25 million Africans now living with HIV, about
8 million also harbour the bacillus that causes TB. Each year,
5-10% of these 8 million co-infected people develop active TB
and up to half, or 4 million, will develop the disease at some
point in their lives.

Without TB treatment, HIV infected people with TB typically die
within months. Yet national TB programmes in Africa are cur-
rently treating less than half of all HIV-positive people with
active TB - despite the fact that they respond just as well to
TB treatment as HIV-negative people, and the cost of TB drugs is
as low as $10 per patient. But few TB patients are currently of-
fered an HIV test, and only a handful receive ARVs. Providing
ARVs to HIV infected TB patients is now a WHO 'standard of care'
policy.

"As we scale up efforts to increase access to ARVs in Africa we
must simultaneously help people living with HIV survive their
bouts episodes with tuberculosis," said Jack Chow, Assistant Di-
rector-General of the World Health Organization. "This is one of
the most effective ways we can help save lives in Africa."

The lack of attention to the risk TB poses for people living
with HIV was highlighted by Nelson Mandela at the recent XV In-
ternational AIDS Conference in Bangkok in July. "TB is too often
a death sentence for people with AIDS," Mandela said. "Today we
are calling on the world to recognize that we can't fight AIDS
unless we do much more to fight TB as well."

At the Addis Ababa meeting, the TB/HIV Working Group of the
global Stop TB Partnership - comprising experts from WHO,
UNAIDS, the Centers for Disease Control and Prevention, USAID
and other international bodies, as well as Zackie Achmat and
other leading African AIDS activists - called for rapid uptake
by African governments of collaborative interventions to tackle
the two diseases simultaneously.

In addition to strengthening DOTS* programmes in Africa to diag-
nose and treat TB, these interventions include regularly offer-
ing counselling and testing for HIV into TB control programmes;
screening for TB in HIV/AIDS programmes; and providing preven-
tive therapy for co-infected people to prevent the development
of TB disease. Managers of several DOTS programmes in Africa
have already committed themselves to support the delivery of
ARVs to TB patients who are HIV-positive.

The Working Group also pledged to provide technical assistance
to any country wishing to submit a TB/HIV proposal for the next
round of the Global Fund Against AIDS, Tuberculosis and Malaria
(GFATM).

"We cannot talk seriously about fighting AIDS while ignoring
TB," said Richard Feachem, Executive Director of the Global Fund
to Fight AIDS, TB and Malaria. "In Africa, TB and HIV collabo-
rate to kill." Feachem said the Global Fund will modify its pro-
posal guidelines to request that AIDS proposals also include a
strategy to address TB, and likewise TB proposals also include
HIV/AIDS.

In some regions of Africa, 75% of TB patients are infected by
HIV. Yet in Ethiopia, Kenya, Mozambique, Uganda and Zimbabwe,
fewer than 40% of people living with both TB and HIV are receiv-
ing proper TB treatment. In Nigeria, less than 10% of these
cases are receiving proper TB treatment.

*DOTS is the international recommended strategy for controlling
TB that is now implemented in 180 countries world wide. It has
five components: It has five components: political commitment;
microscopy services; drug supplies; surveillance and monitoring
systems; and the use of highly efficacious treatment regimes
with direct observation of treatment.