December 1 is World AIDS Day, a day to solemnly reflect on the more than 35 million lives lost to HIV/AIDS, to stand in solidarity with communities affected and to mobilise action against the epidemic. TB is the leading cause of death among people living with HIV, making addressing TB-HIV co-infection a vital part of the global response against HIV/AIDS.
On this World AIDS, Day, we’re calling attention to five recent pieces of research that can help improve the response to TB-HIV. Please read and share.
1) Uptake of ART among TB-HIV co-infected clients in Nairobi, Kenya
Research conducted in an area of Kenya shows that it’s feasible to rapidly increase the numbers of people with TB and HIV who have access to antiretroviral therapy (ART). In Kenya, half of people with TB are also living with HIV, and national guidelines say that they should receive immediate access to lifelong ART. In a targeted TB control zone in Nairobi, however, only 29% of these eligible people were receiving ART in 2010. By improving how TB clinics followed up with patients to ensure they received ART, and by hiring community health workers to escort TB patients to the clinic where they were enrolled on ART, uptake of ART increased from 29% in 2010 to 80% by 2013.
This research was presented at the 45th Union World Conference on Lung Health (28 October-1 November 2014). See abstract #OPP-407-01 on page S547 here.
2) The cost of TB screening in Gauteng, South Africa
On an individual basis, providing routine TB screening to a person living with HIV is inexpensive. But what happens in a country like South Africa, where the numbers of people living with TB-HIV co-infection are extraordinarily high? Perhaps surprisingly, there aren’t many data on the total cost. In this study, researchers found that the average cost of screening a person living with HIV for TB was $3.39 when the test was conducted by a professional nurse, compared to $1.38 when it was conducted by a lay health worker. With more than 5 million people living with HIV in South Africa, this is a major savings, and the researchers recommend that the government of South Africa explores using lay health workers more often to provide TB screening as a way to reduce costs and improve TB screening rates.
This research was presented last month at the 45th Union World Conference on Lung Health (28 October-1 November 2014). See abstract #PD-1069-01 on page S448 here.
3) Why do presumptive TB cases refrain from HIV testing in Karnataka, India?
People in India who are suspected of having TB are supposed to receive provider-initiated HIV testing, but not all of them do. This study by researchers at the State TB Centre in Bangalore shows some of the main reasons why. They collected HIV testing data for 41,325 people suspected of having TB, all of whom were also supposed to receive an HIV test at the same health facility where they were being tested for TB. However, only 62% of them did. The most common reasons were: HIV testing was not available at the health facility (this happened 78% of the time); individuals either refused to receive an HIV test or were not given one because of their advanced age (12%); and/or there were no testing kits or personnel available (8%). This demonstrates that when HIV testing for TB patients fails to happen in India, the cause may more often be due to a lack of testing capacity than to a lack of willingness among those are supposed to receive the tests.
This research was presented at the 45th Union World Conference on Lung Health (28 October-1 November 2014). See abstract #PD-1070-01 on page S448 here.
4) Tuberculosis is associated with non-tuberculosis-related deaths among HIV/AIDS patients in Rio de Janeiro
In a study published in the December 2014 issue of the International Journal of Tuberculosis and Lung Disease, researchers divided a large study sample of people living with HIV into two groups: those who had developed active TB disease at some point, and those who had not. They found that those who had had TB, even when it was successfully treated, had double the risk of dying from a non-TB related cause than other people living with HIV. The researchers concluded this increased risk is probably due to long-term immune deficiency or an incomplete recovery of the immune system after having TB. They found that antiretroviral therapy and TB prophylactic treatment each protected people living with HIV from dying from non-TB-related causes.
5) Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries
Drug-resistance threatens the ability of public health programmes to control TB among people living with HIV. In a study published in the November 2014 issue of the International Journal of Tuberculosis and Lung Disease, researchers assessed 47 ART programmes across sub-Saharan Africa, Latin America and the Asia-Pacific with regard to their capacity to diagnose and treat drug-resistant TB (DR-TB). They found that ART programmes had limited capacity to carry out this function, and that a lack of directly observed treatment (DOT) for TB – where health workers ensure that people with TB take their medicine as prescribed – and regular interruptions in TB drug supplies may be contributing to the global emergence of TB drug resistance. Less than half of the ART programmes assessed were able to provide any kind of testing for drug-resistance; 30% had no access to medicines needed to treat DR-TB; and of those programmes that had access to medicines, 38% reported facing regular interruptions in drug supplies.
Download the Abstract Book from the 45th Union World Conference
Download Implementing Collaborative TB-HIV Activities: A Programmatic Guide