PartnersGF - 2004-07-09
1st Partnership Forum: TB & HIV
HDN Key Correspondent Team
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In my own experience many people with HIV died of tuberculosis (TB). In fact TB is the single largest killer of people living with HIV. But this simple fact has not been acknowledged by the world.
These are the words of Winstone Zulu of Kara Counseling and Training Trust, Zambia. He has come to Bangkok to participate in the two-day Global Fund Partners Forum. A number of delegates taking part in the Forum share his concerns. They are anxious over the inordinate delay in initiation of a combined initiative against the dual epidemic in countries reeling under the burden of twin killers.
In sub-Saharan Africa, 70 to 80% of TB patients are HIV positive. Globally, at least 50% of HIV positive patients develop TB at some point in their life. In India alone there are 4.5 million co-infected patients says a delegate representing the Stop TB Partnership. The countries in sub-Saharan Africa and Asia seem to have failed to address the desolation brought about by TB and HIV together, he laments.
TB control is still considered a low priority; probably it is not the sexy thing, laments Mr Zulu. The Global Funds allocation for TB has been persistently low so far. Its expenditure on TB in the two year budgets from round ones to four [between 2002 and 2004] has been 397 million dollars as compared to 1,666 million dollars spent on HIV. It has spent scarcely 94 million dollars on joint HIV/TB programmes. In Zambia, merely ten percent funds have been spent on TB, says the AIDS activist.
It is possible to achieve the 85% cure rate in patients being treated for TB using Directly Observed Treatment Short-course (DOTS) says Mark Harrington, Executive Director of Treatment Action Group based in New York, but it can be difficult to realize 70% case detection rate in communities with high HIV burden, as envisaged under DOTS. This is because sputum examination may be negative or the TB may turn out to be extra-pulmonary in HIV positive persons and by definition these patients may not be brought under DOTS umbrella.
The World Health Organisation has now produced an Interim Policy on TB and HIV. This is a useful document that everybody on the Global Fund board and Country Coordinating Mechanisms (CCMs) should have a copy of, suggests Mr Harrington. Until round four of the Fund there was no such policy, but now that it is available CCMs should keep it in mind during future funding rounds, he demands.
The delegate from Stop TB Partnership concurs, and describes the three key components of the Interim Policy, intended to be adapted to the needs of individual countries:
- Active TB case finding amongst people living with HIV.
- Provision of isoniazid preventive therapy to HIV positive persons.
- HIV care and antiretroviral therapy for TB with HIV.
- HIV testing offered to TB patients.
He also agrees that the Global Fund now has to play a more proactive role to accomplish integration of TB and HIV control activities. He hopes that country proposals will reflect the WHO policy elements in future funding rounds.
Winstone Zulu feels that there is a need for greater awareness about TB. In his view, specific goals and targets to integrate TB and HIV programmes should be developed. TB can longer be treated the way it has been in the past.
India has taken the lead in setting up joint TB and HIV programmes. In 2002 it launched a joint Revised National Tuberculosis Control Programme (RNTCP) and Voluntary Testing and Counselling Co-ordination (VTCC) plan.
The first phase of the VTCC was partly supported by the Global Fund, and covers eight states of the country suffering from high HIV prevalence. The second phase of the plan is entirely GF-sponsored, and has launched VTCC activities in eight more states. Its main components include sensitisation of key policy makers, training of physicians and laboratory technicians, infection control and information, education and communication activities. The programme is doing well in some of the target states, according to a RNTCP officer attending the Partners Forum.
It is too early to speculate on the outcome of these joint TB/HIV initiatives in India. But at least a beginning has been made, and many delegates feel this needs to be emulated by other countries.
HDN Key Correspondent Team
Email: correspondents@hdnet.org