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TB Control in HIV Care Programmes Beneficial in Developing Countries, Say HIV Experts CHICAGO -- July 22, 2008 -- HIV care and treatment programmes 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, according to an article in the July 23 issue of the Journal of the American Medical Association. "As HIV care expands further, there is both an opportunity and necessity for incorporation of TB-control activities into programs. TB programs simply do not have the capacity to provide ongoing screening, prevention, and treatment for millions of individuals receiving HIV care," the authors wrote. Diane V. Havlir, MD, University of California, San Francisco, California, and colleagues examined interactions between HIV and TB for HIV care programmes and the framework for HIV programmes to incorporate TB activities, and global progress in implementation. "Finding and treating TB cases, administering antiretroviral therapy (ART) and isoniazid preventive therapy (IPT), and infection control are critical activities to incorporate into HIV care programs," the authors wrote. "Because patients with HIV are at risk for TB throughout life, activities should be ongoing in paediatric and adult ART clinics, pre-ART clinics, and maternal health programs." The authors propose several strategic approaches to reduce TB burden for HIV care and treatment programmes. They include: · TB intensified case finding: Finding and treating TB promptly. Intensified case finding includes both active identification of TB among patients with HIV in care and screening their household members for active TB. · Treating individuals with active TB: Expansion of a care model whereby TB is treated by HIV programmes. HIV care staff are trained to diagnose and treat a wide array of infections associated with HIV disease, TB should be no exception. · IPT: HIV programmes may need to work with country policymakers to permit IPT administration, which in some countries is either against national policy or impossible because of the stringent requirements for the exclusion of TB before IPT initiation. · ART: From the perspective of TB prevention, the earlier that ART is initiated, the lower the risk for TB. · TB infection control: One of the most challenging areas in TB infection control is the implementation of measures in both outpatient and inpatient healthcare facilities that will reduce the risk of TB transmission and protect healthcare workers. TB infection-control guidelines exist but are rarely implemented. · TB recording and reporting: It is essential that HIV care programmes adhere to TB reporting requirements. Standardised recording and reporting formats in accordance with national TB- and AIDS-control guidelines should be used. · Joint HIV/TB planning: The successful implementation of TB interventions in HIV services requires effective communication, coordination, and collaboration with TB-control programmes. "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," the authors wrote. "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," the authors said. "The possibility for progress has never been greater with the global commitment to healthcare infrastructure strengthening geared toward consolidating the momentum through disease-specific efforts such as HIV and TB." SOURCE: Journal of the American Medical Association E-mail this page to a friend or colleague! To print, use this version