Book Reviews | Gordon Campbell | News Flashes | Scoop Features | Scoop Video | Strange & Bizarre | Search

 


'Every TB-HIV case is a public health failure...'

'Every TB-HIV case is a public health failure...'

by Shobha Shukla
July 24, 2014

So said Helen Ayles. She was quoted by Dr Diane Havlir who was speaking in the plenary of the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia. Dr Diane Havlir who is a researcher at the University of California, San Francisco, was hopeful that "Every HIV/TB case prevented and every death averted should become a public health success and put us one step closer to ending the dual epidemic of HIV and TB."

Agreeing that policy advocacy and implementation during the last 10 years has seen a 40% decline in TB related HIV deaths and saved over 1.3 million lives, Dr Havlir rued that despite evidence based prevention for HIV-TB co-infection; despite new state of the art TB diagnostics, and despite the ability to cure TB and to reduce mortality with antiretroviral therapy (ART), there are still over 1 million new TB cases in people living with HIV (PLHIV) and 320,000 TB related deaths in people living with HIV (PLHIV) every year.

She said that, “To step up the we need to: understand who is dying and why they are dying; adapt evidence based care delivery systems that are patient centric; pay more attention to most at risk populations (MARPs) for HIV/TB; and invest in research to improve prevention, diagnosis and treatment.”

India stands 3rd among the top 10 countries with highest TB related deaths in PLHIV every year (42,000). All the other countries are in Africa, with South Africa topping the chart with 88,000 such deaths every year. The main reason for this high mortality is obviously not diagnosing and treating people early enough. So, the mantra is-- Diagnose and treat TB and diagnose and treat HIV.

Preventing TB in PLHIV
A combination prevention treatment of ART and isoniazid preventive therapy (IPT) can result in substantial reduction of TB in PLHIV. Studies have shown that early start of ART in PLHIV results in 65% reduction in TB cases and providing ART and IPT gives an additional 35% reduction in TB in high TB transmission areas.

TB in HIV+ children
Dr Havlir agreed that children could not be left behind while we step up the pace to arrest the march of TB and HIV/AIDS. Childhood TB infection is relevant to all HIV/TB and TB control as much of the global TB reservoir is established in childhood itself. According to latest WHO estimates, over 650,000 children are infected with TB every year and around 75,000 deaths from TB occur in HIV negative children.

Dr Mario Raviglione, Director of the World Health Organization (WHO) Global Tuberculosis Programme had earlier told Citizen News Service (CNS) that, “In the absence of any data, TB related deaths in HIV positive children cannot be estimated. But given that HIV positive children are more vulnerable to TB, these deaths could be in the range of 100000 deaths every year.”

Dr Havlir said that, “Children have more rapid progression of TB from infection to disease as compared to adults. TB diagnosis is more difficult in children than adults. TB/ART dosing is more complex and cascade of care is more challenging. The way forward is to prevent all parent to child transmission of HIV; start ART in all HIV positive children and put all children exposed to TB cases on IPT. One study has shown an 8.8 fold increase in deaths in those children not starting ART compared to those stating ART within 2 months of TB diagnosis.”

Dr Steve Graham, lead author of the WHO Guidance on Childhood TB and Childhood TB Roadmap, told CNS that, “Study from Thailand shows that children who are living with HIV and also get TB have a much poorer survival curve than those children who do not get TB. Studies from Vietnam show that giving IPT and ART to children living with HIV give much better result in terms of child health and child survival. After Childhood TB Roadmap, we are trying to get a better handle on TB and TB-HIV in adolescents, which is another neglected area.”

There is an urgent need for more research to have better point of care diagnostics and simpler, shorter drug regimens for all forms of TB. But till then, Dr Havlir appealed for monitoring and fixing the HIV/TB care cascade with the existing tools. Early diagnosis of TB in PLHIV and early start of ART (within 2 weeks of diagnosis) in PLHIV diagnosed with TB along with TB treatment will go a long way to stem the tide of TB related deaths in people living with HIV.

*************

Shobha Shukla 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. www.citizen-news.org

© Scoop Media

 
 
 
 
 
Top Scoops Headlines

 

Gordon Campbell: On The Delusions Driving The “Leave” Option

Voting for “Leave” requires (a) a fantastically unbalanced view of the impact of immigration on modern Britain (b) a demonizing of the EU “regulations” that are commonplace within a modern economy and (c) a simple-minded optimism that Britain would not suffer any major damage to its economy, or to the status of the City of London. More>>

ALSO:

Gordon Campbell: On The “T” Word, And This Sunday’s Election In Spain

Once again, the RNZ news packages from the US and UK this morning underlined the striking difference in the treatment of the Pulse night club killings in Florida and the murder of the British Labour MP, Jo Cox. More>>

Werewolf: Getting Roasted, Kiwi Style

Roasting coffee beans is an essential step in the process from plant to cup. New Zealand does not grow any coffee, so it therefore imports 100% of its coffee supply from other countries. New Zealand does however roast a lot of coffee beans. More>>

Alastair Thompson: Jo Cox's Killing Looms Large As Brexit Heads Down To Wire

The mourning period for the brutally slain pro-remain Labour MP and mother of two Jo Cox was always going to be brief. Today, Sunday 19th June, with four days to go till polling, the Brexit campaign resumed. More>>

ALSO:

Pledge Me Goal Met!
On Scoop's Current Journalism Project

Gordon Campbell: Before this crowd funding effort wraps up tonight, I thought I should provide an update on the mental health journalism project that Scoop – and its readers – are funding. More>>

ALSO:

Thanks Joining Us! Scoop Turns 17; Has Party

Margaret Thompson welcomed visitors to Scoop's birthday celebration on Wednesday night and reflected on the state of the media during a year in which Scoop formed its new structure... More>>

ALSO:

Get More From Scoop

 
 
 
 
 
 
 
Top Scoops
Search Scoop  
 
 
Powered by Vodafone
NZ independent news