BY FRANCIS OKOYE
At a time in the History of the world, for anyone to test positive for HIV was a death sentence. Today medical science have developed new treatment regimes that ensure that people living with HIV can live as long as they like, as far as they have access to HIV drug, but that is about to be put to a stop, with the advancement of TB infections for HIV positive patients.
According to a briefing for news media provided by Citizen News Service in collaboration with the union. Tuberculosis (TB) and HIV are deeply intertwined, particularly in sub-sahara Acrica. TB has become the leading cause of death among those who are HIV-positive, despite the fact that today HIV infections can be managed with antiretroviral medication and TB can be cured in the vast majority of cases.Since HIV infections weakens immune system, a person living with HIV are 26 to 31 times more likely to develop active TB than someone who is negative. Of the 1.2 million people who died from HIV in 2014, one in three deaths resulted from TB-HIV co infection.
According to WHO report at some time, 25 percent of all TB deaths were HIV associated, based on post mortern autopsies nearly half of people living with HIV who died from TB had undiagnosed TB at the time of death.
Drug-resistant TB is a global health crisis and is creating growing challenges to the fight against TB and HIV. According to WHO, an estimated 480,000 people develop multi drug resistant TB (MDR-TB) annually.
Treatment for MDR-TB has historically been very difficult and even more difficult for people living with HIV. The first ever recorded outbreak of extensively drug resistance TB happened in the Kwazulu Natal Province of South Africa-the same province where the TB 2016 and AIDS 2016 conference will be held. The outbreak was reported in the medical literature in 2006 of the 53 people infected with XDR-TB, 52 of them died. All of the 44 people with XDR-TB who were tested for HIV were HIV positive. Source: (www.thelancet.com). Since 2006, at least 100 countries have reported cases of XDR-TB.
In a webinar in lead up to TB 2016 and AIDS 2016, held for media recently by citizen news service, Dr Fuad Mirzayes an expert,In his presentation revealed that South Africa is experiencing TB/HIV in Alarming proportion, with high burden of TB, recording 450,000 TB cases, 60% of which have HIV/TB.
Government of UN member Nations have committed to end TB and AIDS by 2030 by adopting sustainable development goals, SDGS, but unless we ensure people living with HIV are not dying of TB, we will not only fail to meet SDGS but also lose gains made in fighting TB and HIV globally.
WHAT MUST BE DONE
We have a number of things we can do to stop people living with HIV dying of TB.
- Joint Approach: The World Health Organization first endorsed a policy approach for jointly addressing TB-HIV in 2004. Since 2005, WHO estimates that 5.8 million lives have been saved by interventions that have jointly addressed TB and HIV, Yet in 2014 only half of TB patients worldwide had a documented HIV test result-the first step in initiating treatment and care for TB-HIV co-infection.
- Advocacy and Collaboration: Experts says that it is only through better advocacy and collaboration across the TB and HIV communities will we find effective,accessible,sustainable solutions that address TB-HIV and save lives-because in fact,the communities affected by TB and HIV are very often the same.
- Focus on TB-HIV: The global health community as a matter of urgency must address the TB-HIV co-epidemic at every opportunity.
- Government Role: In an answer to a question during the webinar on if experts feel governments is playing a bigger role in fight against TB and HIV, the experts said governments are playing a bigger role. It is therefore left for developing countries government to take on leading role in the fight against TB/HIV.
- Stigma and Discrimination: Some countries have introduced laws that fuel HIV stigma, even while the world is trying to wipe out Some of such policy is that some countries ban HIV positive person from entering their country, a law which is unethical.
One of the experts at the webinar, Nomampondo Barnabas, civil society Liason Officer, IUATLD shared her experiences in discrimination against TB and HIV. She had personal experiences in the epidemic having lived with it. She said she was taking 5 TB drugs, 5 ART, 5 Antibotics in 1990-2006 to survive but now in the future, we can find regime for both TB/HIV. She said that most people living with co epidemic never get treated, we need to give the disease a human face and this can be done by the press, WHO and Communities to minimize stigma and discrimination.
People from disadvantage society need to be told about TB and HIV education at school level more meaningful –not impose on them but recruit students to do it, so it comes from them.
- Use of shorter regime for MDR-TB: The adoption of shorter regime for MDR-TB would ensure that less people living with HIV and TB die. The regime recorded treatment success rate of high average 84% and cost $1000 in drugs costs /patients. The STREAM trial is limited to certain countries but should be adopted by all.
WHO has also revealed some changes in 2016 recommendation on shorter regime for MDR-TB.
- Tb children living with HIV: Uniform availability of services-a challenges as well as early diagnosis and under nourishment of the children often are problems faced.
- Examples of India: K.S Sachdeva, an India expert gave example of TB/HIV collaboration in India showing that 85% know they are HIV positive, while 95% HIV/TB patients are receiving ART.
The webinar was moderated by Ashok Ramsamp former SABC radio producer and Shobha Shukla, of citizen new service.