New One-roof Policies on TB, HIV/AIDS ‘are Challenging’. 3/11/10

Putting the government’s new policies for integrating tuberculosis (TB) and HIV/AIDS care into practice was proving extremely challenging.

Business Day

Cape Town— Putting the government’s new policies for integrating tuberculosis (TB) and HIV/AIDS care into practice was proving extremely challenging, the head of Cape Town municipality’s HIV, TB and sexually transmitted infections unit, Dr Karen Jennings, said yesterday .

Historically public health facilities have run separate programmes for TB and HIV/AIDS care. The new policy says services should now be provided under one roof, as many patients are infected with both diseases. HIV/AIDS attacks the immune system and increases susceptibility to other infections, including TB.

“It’s complex,” said Dr Jennings, explaining that both the Cape Town municipality and the Western Cape provincial health department provided TB and HIV services in the city, but not necessarily at the same place.

Addressing delegates to the seventh annual meeting of the Consortium to Respond Effectively to the AIDS TB Epidemic (Create) , an initiative funded by the Bill and Melinda Gates Foundation , Dr Jennings said her department had started introducing simple tools to help integrate care for the twin epidemics.

One example was a specially designed clinic card that included a prompt for TB testing for newly diagnosed HIV patients, she said. Newly diagnosed TB patients were increasingly being tested for HIV too, Dr Jennings said.

Last year 29526 new TB patients started treatment in Cape Town, of whom 83% took an HIV test. Of those who were tested, half were HIV positive, she said.

One of the biggest challenges in providing TB tests to HIV- positive people was that most HIV/AIDS patients were not getting regular medical check-ups until they fell ill or started taking HIV/AIDS drugs . Only about a quarter of HIV/AIDS patients who were not on treatment were in regular care, Dr Jennings said.

Create was set up to try and identify public health strategies that could drive down TB rates in parts of the world with large HIV/AIDS epidemics . With one of the world’s worst such epidemics, SA also has the highest co- infection rate: almost 50% of the people worldwide who are infected with both diseases live in the country.

Delegates also heard about research from Matlosana (Klerksdorp) in North West showing that “active case finding” for TB was an effective way to identify people who were infected with TB, even if they were not yet symptomatic.

Researchers were spurred by the fact that a quarter of TB patients admitted to the local hospital died, suggesting they were getting help too late, said Adrienne Shapiro from Johns Hopkins University .

Active case finding involves sending a health worker to test people living in the same households as TB patients, and this turned out to be a much more effective strategy for finding TB patients than testing randomly selected households in communities, Ms Shapiro said.

The researchers found 8% of the household contacts of TB patients who agreed to take tests were also infected, and only 11% of them had any symptoms, she said.

About 10% of them also had undiagnosed HIV/AIDS.

“Active case finding is feasible and acceptable, but there is still a gap — 35% (of the study participants) said no to voluntary counselling and testing (for HIV) and it is difficult to screen children,” she said.