Human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings must aggressively address tuberculosis (TB) and the emerging multidrug-resistant TB epidemic to save patient lives and to curb the global TB burden, a major cause of death for persons with HIV, according to an article in the July 23/30 issue of JAMA .
Tuberculosis is a threat throughout the course of HIV disease. "As HIV care expands further, there is both an opportunity and necessity for incorporation of TB control activities into these programs. Tuberculosis programs simply do not have the capacity to provide ongoing TB screening, prevention, and treatment for millions of individuals receiving HIV care," the authors write.
Diane V. Havlir, M.D., of the University of California, San Francisco, and colleagues examined interactions between HIV and TB for HIV care programs and the framework for HIV programs to incorporate TB activities, and global progress in implementation.
The authors write that TB poses numerous challenges, including drug-resistance; difficulty in diagnosis and treatment in HIV-infected persons; and complications from drug interactions. "Finding and treating TB cases, administering antiretroviral therapy (ART) and isoniazid preventive therapy [IPT; an antibacterial drug], and infection control are critical activities to incorporate into HIV care programs, the first chronic care models to emerge in many developing countries. Because patients with HIV are at risk for TB throughout life, activities should be ongoing in pediatric and adult ART clinics, pre-ART clinics (keeping relatively healthy patients engaged in care), and maternal health programs."
The authors propose several strategic approaches to reduce TB burden for HIV care and treatment programs. They include:
"HIV care programs must take a bold approach to TB prevention, diagnosis, and treatment to successfully address the catastrophic and intersecting epidemics of HIV and TB. HIV programs need to take advantage of new earmarked funds for HIV/TB activities from agencies such as PEPFAR and the Global Fund to Fight HIV, TB, and Malaria. They must push for access for rapid TB diagnostic tests, conduct operational research, and launch educational efforts in partnership with the community to reduce TB transmission. Shortages in the health care workforce and laboratory capabilities clearly represent the greatest obstacles. However, the possibility for progress has never been greater with the global commitment to health care infrastructure strengthening geared toward consolidating the momentum through disease-specific efforts such as HIV and TB," the authors conclude.
( JAMA . 2008;300[4]:423-430. Available pre-embargo to the media at www.jamamedia.org )
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