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Activists call for integrated HIV/TB services

Waiting for TB treatment
(Gary Hampton/World Lung Foundation)

A consortium of AIDS organizations has given the South African government three months to deliver on promises to integrate TB and HIV services.

A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF), and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in the port city of Durban.

MSF spokesperson Lesley Odendal called the three-month deadline "generous" because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implemention plan.

"Patients are still going to different sites, and healthcare workers still have not been trained on new guidelines," said TAC Deputy Secretary General Lihle Dlamini. "One patient who has both diseases should be seen by one healthcare worker with one file."

Dlamini noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs.

Krista Dong, of the Integration of TB in Education & Care for HIV/AIDS (iTEACH) Programme, based at Edendale Hospital in KwaZulu-Natal Province, said proper training of healthcare workers was crucial.

She cited recent research by Health Systems Trust, a non-profit health research organization, which found that nurses' knowledge of potentially dangerous HIV and TB drug interactions continued to be problematic, even with training.

A matter of time

The deadline was set just hours after a speech by South African Health Minister Dr Aaron Motsoaledi, in which he expressed dismay that South Africa's TB epidemic was among the world's most severe, while the country also had the highest rate of HIV/TB co-infection.

According to MSF, more than 70 percent of South African TB patients are co-infected with HIV, and TB is the leading cause of death in people living with HIV.

"The dual TB/HIV epidemic is a public health emergency, and the most important public health challenge of our time," Motsoaledi told IRIN/PlusNews. "It's no longer an issue of debate [whether treatment should be integrated], it's a matter of implementation."

Motsoaledi said his department had requested help from the World Health Organization and UNAIDS, but implementation would not happen overnight.

Read more:
 TB and HIV co-infection a bigger threat
 HIV testing and treatment to prevent TB
 "What made me really mad was the failure to diagnose my TB in good time"

Already in progress

MSF began integrating HIV and TB services five years ago at its clinics in Khayelitsha, a sprawling township outside Cape Town. Odendal said that once clinics had official approval, and community consultations had taken place, it took about three months to implement integrated services at each of their 11 clinics.

Putting HIV and TB services under one roof has improved case detection, decreased the number of patients lost to follow up, and increased the proportion of co-infected patients on ARVs. The organization will present research on the benefits of TB/HIV integration at the upcoming international AIDS conference in Vienna.


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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