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Dr Rewari said that challenges still remain. Annual notification remains less than 50% of the estimated HIV associated TB cases (130,000/year). Mortality is high and 42000 co-infected patients (15%) die every year. Only 6724/13232 (51%) of the designated microscopy centres (DMCs) have co-located HIV testing facilities. Late diagnosis of HIV and that too at low CD4 count is another formidable challenge. Dr Rewari also pointed out to the leaky care cascade for HIV as it is very difficult to track lost to follow up (LFU) patients. Airborne infection control is difficult due to over-congested health facilities, said Dr Rewari. Another challenge is that cases with extra pulmonary TB (EPTB) might be getting missed. Also there is a poor detection of TB among children living with HIV.
Looking forward Dr Rewari said that Scaling up of systematic infection control interventions by bringing airborne infection control into focus at health facilities and allocating funds for each ART centre for infection control measures is a priority. IPT should get operationalized in 2014 for PLHIVs. Early detection of HIV associated TB and scale-up of HIV testing among presumptive TB cases has already approved by National Technical Working Group and should be implemented well. Scaling up of PICT among presumptive TB cases in high HIV prevalence states and in 25-54 years age group in low HIV prevalence settings is another priority. Travel support for TB-HIV co-infected people is also being planned. Mobility support to senior DOTS Plus and TB-HIV supervisors for better TB/ HIV co-ordination is also being planned. Dr Rewari said that vision of the revised national TB control programme (RNTCP) for 2012-2017 is to have coordinated service delivery with the Department of AIDS Control of Government of India, to ensure that TB patients living with HIV, receive seamless care for both the diseases.
In an interview with Citizen News Service (CNS), Sirinapha Jittimanee of the National Tuberculosis Programme in Thailand, shared the successes and challenges of TB-HIV collaborative activities in Thailand.
SUCCESSFUL HIV-TB INTERVENTIONS: Thailand has integrated PICT for HIV among TB patients, which has led to an increase in the number of TB patients accepting HIV test. About 60,000 (90%) TB patients accepted HIV testing in 2013. Those TB patients who do not accept HIV testing are usually either children or very old. There has been increased coverage of ART among TB patients who are co-infected with HIV. In 2013, more than 65% of TB patients who were co-infected with HIV were receiving ART along with anti-TB treatment, which is more than double the figure of 30%, 5 years ago.
KEY CHALLENGES/NEXT STEPS: Less involvement of civil society partners in TB programme is a challenge. While a very large number of civil society organizations partner with the National AIDS Programme, only 2-3 organizations partner with National TB Programme. Having more peer groups among PLHIV can help in increasing TB screening of PLHIV as they have a range of initiatives to support each other. Having more partners from civil society will definitely improve programme outcomes.
Community engagement is another area of concern. Community engagement has reduced stigma and discrimination related to HIV. But in case of TB this is not happening effectively. Thailand health system is such that community hospitals play a key role in TB diagnosis and treatment. But community hospitals often have weak linkages with the community. Community can help support lot of activities of TB programmes to strengthen them, increase performance of DOTS, provide patient support as TB patients mostly are very sick and peer support will help a lot. Community organizations can help very sick TB patients as well.
In Thailand, collaboration with National AIDS programme is somewhat passive so this perhaps can be improved, said Sirinapha Jittimanee.
Dr Anthony Harries, Director, Department of Research at the International Union against Tuberculosis and Lung Disease (The Union) also insists that, “A more formal collaboration between the TB and HIV/AIDS Programme, is needed to reduce TB related deaths in PLHIV. Better control of HIV and instituting widespread ART will be crucial to reduce the risk of TB in high HIV-prevalence areas. The important thing is to test all TB patients for HIV, ensure good post-test counseling, and start all HIV infected TB patients on cotrimoxazole preventive therapy and ART as soon as possible.”
Shobha Shukla, Citizen News Service (CNS)
(The author is the Managing Editor of Citizen News Service – CNS. She is reporting from the XX International AIDS Conference (AIDS 2014) with support from the World Health Organization (WHO) Global Tuberculosis Programme. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore.
She has earlier worked with State Planning Institute, UP and taught physics at India’s prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email: [email protected], website: www.citizen-news.org)
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