HIV programmes are still failing to integrate TB prevention and care into their work, and TB remains the biggest killer among HIV-positive people as a result, experts and advocates said on the opening day of the 38th World Lung Health conference in Cape Town.
“It’s a scandal in my mind that not all HIV patients are being screened for TB,” said Dr Paula Fujiwara of the International Union Against Tuberculosis and Lung Disease, speaking at a press conference on HIV and TB.
“If we screened all people living with HIV for TB, we could save thousands of lives,” said Dr Alasdair Reid, TB/HIV Liaison at UNAIDS.
The burden of HIV and TB coinfection is still poorly characterised, although WHO has tried to make estimates. The Stop TB Partnership believes that 600,000 cases of TB occur in HIV-positive people each year, of whom one-third will die.
“Governments should routinely report the proportion of TB patients who are coinfected with HIV,” said Dr Mario Raviglione, Stop TB director of WHO. At present reporting rules vary: in some countries, such as South Africa, deaths in coinfected people are recorded as TB, while in Brazil, coinfected people who die of TB are likely to be described as having died of an HIV-related cause, said Ezio Santos Filho, a TB and HIV community advocate from Brazil.
Five thousand activists marched to the conference centre on Thursday night to present a global call to action against tuberculosis. They described the current state of TB/HIV management as unacceptable and inadequate, a view endorsed at the conference’s opening ceremony by the new president of the Union Against Tuberculosis and Lung Disease, Dr Asma El Sony of Sudan.
The call to action highlights four areas in which national health ministries need to take urgent action:
- Improving infection control to prevent infections in health care settings, especially where large numbers of HIV-positive people are concentrated.
- Testing more people with HIV for TB, and vice versa.
- Integrating and decentralising TB and HIV services.
- Preventing and treating drug-resistant TB.
The South African government announced on Thursday that it is committing an extra 400 million rand to combating drug-resistant TB, but activists say the money is a year overdue. South African and international experts began to call for greater investment in drug-resistant TB in September 2006 after the international medical community learnt of an outbreak of extensively drug-resistant TB in rural KwaZulu Natal, the South African province most severely affected by HIV and TB.
At the conference’s opening ceremony, health minister Manto Tshabalala Msimang brushed aside criticisms of the government’s record. “Pointing fingers at each other about how drug resistant TB developed is not going to be productive,” she said.
However treatment activists say that chronic under-investment in the health service and TB control have led directly to a situation in which South African hospitals do not have enough beds to treat patients with MDR TB in isolation, nor to institute proper infection control measures.
Countries throughout the developing world could reduce the burden of TB in HIV-positive people by adopting one apparently simple measure – providing isoniazid preventive therapy (IPT) to people with HIV – the Stop TB Partnership’s TB/HIV working group said in a formal statement.
“The cost is pennies” said Dr Paula Fujiwara, yet only 25,000 HIV-positive people are receiving IPT worldwide, most of them in Botswana.
“Tuberculosis is the disease most likely to kill people with HIV,” said Winstone Zulu, a treatment activist from Zambia. He received treatment for TB in 1996, long before antiretrovirals were available in Zambia. “In all my years of living with HIV, TB is the only thing that nearly killed me.”