Experts want to boost coordination of TB and HIV programs to better fight TB/HIV
Panama City, Panama, 5 July 2011 (PAHO/WHO)—Fewer than half of tuberculosis patients in Latin America and the Caribbean are currently tested for HIV, and people living with HIV are not always screened for TB even if they show symptoms of the disease.
As a result, most people in Latin America and the Caribbean who are coinfected with both HIV and TB do not know it and are not receiving treatments that could cure or reduce illnesses and prevent deaths from both diseases.
Public health experts say the problem stems from insufficient coordination between programs aimed at HIV/AIDS patients and programs for TB patients. The Pan American Health Organization/World Health Organization (PAHO/WHO) will host two meetings this week in Panama City to promote stepped-up coordination among these programs and with other public health partners, particularly in civil society.
The impact of TB/HIV coinfection is worrisome. Worldwide, TB accounts for nearly one in four deaths among people with HIV, according to WHO estimates. People with HIV infection are 20 to 30 times more likely to develop active TB disease than people without HIV.
Moreover, people with HIV are at risk of infections with drug-resistant TB, which does not respond to first-line antibiotics, as well as extensively resistant TB, which resists both first- and second-line anti-TB drugs. In these cases, mortality is extremely high.
The best way to address these problems, experts say, is through increased collaboration between healthcare providers and TB and HIV programs and through joint monitoring and surveillance of the two diseases.
“There are excellent examples of coordination between TB and HIV programs in Latin America and the Caribbean that have produced better prevention and treatment of the TB/HIV coinfection,” said PAHO Director Dr. Mirta Roses. “We need to multiply these examples across our region. We’re asking ministries of health to step up coordination between their TB and HIV programs, using an integrated approach to prevent these diseases and to better help those who suffer from them.”
To promote this integrated approach, PAHO/WHO is bringing the heads of national HIV and TB programs from 18 Latin American and Caribbean countries to Panama City this week (July 6-8) to meet with HIV and TB experts from PAHO/WHO and other agencies including UNAIDS, USAID, the U.S. Centers for Disease Control and Prevention (CDC), the Pan American Association of Infectology, United Nations Office on Drug and Crime (UNODC) and the International Labour Organization (ILO), among others.
In addition, UNAIDS will host a workshop on “Accelerating Advocacy on TB/HIV” on July 6 for representatives of patient advocacy groups and other civil society organizations from 15 countries in the Region.
“By scaling-up collaborative TB/HIV activities, we can achieve the goal of reducing by half TB deaths among people living with HIV by 2015,” said Dr. César A. Núñez, Regional Director of UNAIDS for Latin America. “Universal access to integrated TB/HIV services can be a reality in the region. Civil society involvement is key in advocating for, implementing and sustaining national HIV and AIDS responses and reaching those population most difficult to reach and those most in need to receive potentially life-saving diagnosis and treatment for both diseases.”
In the PAHO/WHO meetings, experts will present recommendations on scaling up collaborative activities between HIV and TB programs such as:
- Surveillance of HIV prevalence among TB patients
- Intensified TB case-finding among HIV patients
- Better TB infection control in healthcare and congregate settings
- HIV testing and counseling for TB patients
- Promotion of HIV prevention among TB patients
- Use of preventive therapies for TB in HIV patients
- Use of recommended antiretrovirals for TB/HIV patients
- Joint planning, monitoring and evaluation of TB and HIV programs
“We’re calling on governments, health providers, academic institutions, and members of civil society to support these efforts,” said Dr. Roses. “HIV and TB are both preventable. For people who are already infected, HIV is treatable and TB is curable. With the proper coordination, we can do a lot to improve the lives of all these patients.”
Founded in 1902, PAHO is the world’s oldest public health organization. It works with all the countries of the Americas to improve the health and quality of life of people in the Region, and its secretariat serves as the World Health Organization’s Regional Office for the Americas.
FACTS ABOUT TB/HIV IN THE AMERICAS - 2009
- An estimated 3.14 million people have HIV in the Region of the Americas, including an estimated 1.86 million in Latin America, 240,000 in the Caribbean, and 1.04 million in Canada and the United States
- 216,000 cases of tuberculosis were reported
- 2,900 cases of multi-drug-resistant TB (MDR-TB) were reported, accounting for 48 percent of total estimated MDR-TB cases
- 41 percent of patients with diagnosed TB were tested for HIV. Of these, 17 percent were found to be coinfected with HIV and TB
- 90 percent of TB patients who are offered HIV tests—as recommended by PAHO/WHO—accept testing
- 61 percent of patients with TB/HIV received cotrimoxazole, an antibiotic that prevents other infections and deaths among people with HIV
- Of an estimated 120,000 new infections with HIV in the Region, only 4,600 (4 percent) received isoniazide to prevent TB disease.
- 73 percent of all patients with TB/HIV in the Region received antiretroviral therapy, the majority of them in Brazil