by Francis Okoye
Medical and Historic evidence now abound, showing that the world cannot fight AIDS by ignoring TB.
According to world AIDS day briefing 2016, sent out by citizen news service, integrated care is critical to saving lives from TB-HIV co infection.
WHO says in a new report recently released that risk of developing TB is between 26 to 31 times greater in people living with HIV. TB being the most common illness of PLHIV. In 2015, the world recorded 10.4 million new TB cases with 1.2 million of it being PLHIV, which is 11% of all cases.
They were 1.4 million TB deaths, 400,000 from TB/HIV, up to 80% of individuals with TB are HIV positive in some countries with high TB burden. The report shows that Asia region accounts for 30% of all TB cases, with 40% AIDS death rate.
Only 77% of PLHIV were placed on ART in 2014, with only 47% of people with ART were screened for TB. 51% of people with TB were tested for HIV. Only 50% of TB/HIV diagnosed and provide with TB care.
In a webinar organized for media by Citizen News Service, in lead up to world AIDS day 2016 on the topic “TO END AIDS BY 2030, WE HAVE TO STOP NEGLECTING TB”. Experts like Dr Anthony Harries, Senior Adviser and Director, Department of research,the Union, Dr. Ishwar Gilada, president AIDS society of India (ASI) and co-chair (org) of 18th NAPCON 2016, Nomampondo Barnabas of International Union against TB and lung disease.
Monisola Ajiboye-a PLHIV, with moderator-Ashok Ramsamp former Senior program producer-SABC and Health Justice lifetime Achievement Award 2016. Shobha Shukla, Managing Editor-Citizen News Service all contributed to the webinar.
According to Dr. Harries, IPT, Isoniazid preventive therapy reduces overall TB risk by 33% in PLHV and 37% reduction in TB using ART and IPT compared to ART alone. ART is protective at high CD4 counts, IPT adds protection to fight HIV/TB.
IPT duration is indefinite for HIV care in TB, if HIV positive with TB, cotrimoxazole preventive therapy CPT is recommended. If you start CPT, 25% -46% mortality reduction is achieved, if you start ART for the same patient 64%-95% CPT mortality reduction. Combining ART with CPT will reduce TB morality and prevent recurrent TB, it will reduce TB incidence.
Dr. Gilada in his webinar discussion explained that TB is 100% curable, but they is always shortage of funds and TB can be found in almost all HIV cases, while HIV is 100% preventable but zero curable and has plenty of funds budgeted for it and HIV may not always be found among TB persons. TB lessons learnt include adherence to treatment to prevent resistance, use of fixed drug combination and importance of case finding and early treatment.
Nomampondo Barnabas speaking on CSO perspective, harped on importance of CSO embarking on educating community about TB and their rights. The need to apply same advocacy applied to HIV to apply it to TB if we want to end AIDS by 2030.
CSO played a great role in HIV education. For TB/HIV, they have been no proper community for outreach and sharing of views. High number of TB are linked to HIV. Nomampondo said there is confusion and alarm and shock at the WHO report to end AIDS by 2030. Organizations focusing on HIV don’t do enough around TB-realignment is needed.
Monisola Ajiboye revealed her experience living with TB/HIV. She had a terrible experience in 2005 .They were no comprehensive center for HIV/TB at same time, so she visited two different places, at the TB center, she did not tell them she had HIV. She did not know she was not to take some drugs, hence had complication. She spent 6 months at the HIV clinic before she survived.
She stated the need to involve community about TB awareness, In Nigeria as at 2016 they are still communities who know very little about TB. TB kills faster than HIV, every month we record 10 new cases. Some have MDR TB, even people under 16yrs with recession in Nigeria many are dying, we recently lost a TB patient so died due to lack of nutrition. We need funding partners. She said that those at the grass roots can create more awareness in community.
URGENT ACTION NEEDED
The WHO global TB report 2016 shows increase (not decrease) in TB cases and TB deaths. TB leading cause of death of PLHIV. TB being curable and preventable, this is unacceptable. If funders fail to design programmes for TB without input from Communities, it is bound to fail. Diabetics have 3 times more risk of getting TB ,if TB patients get diabetes, risk of dying is higher. PLHIV can develop HBP; hence they should measure BP regularly.
The union integrated HIV care for TB patients living with HIV/AIDS (IHC) is to strengthen collaboration and build capacity of affected countries general Health System to deliver high quality HIV and TB care. From 2000-2014 WHO estimate, 8.4 million lives saved by it WHO recommend patients with presumptive or diagnosed TB should be tested for HIV. If diagnosis is delayed PLHIV at risk of death from multi drug resistant tuberculosis MDR TB and extensively drug resistant TB, XDR-TB.