This is our regular bulletin that highlights recent publications and announcements on HIV and AIDS issues.
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In this issue:
- Approaches to TB/HIV Integration
- Tuberculosis control has failed in South Africa: time to reappraise strategy
- Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource constrained settings
- Supporting community based responses to AIDS, TB and malaria: a guidance tool for including Community Systems Strengthening in Global Fund proposals
Approaches to TB/HIV Integration
Produced by: International HIV/AIDS Alliance (2011)
This paper explains the close linkages between TB and HIV, and why there is an urgent need to put into place rigorous measures to integrate TB and HIV responses globally. It outlines what approaches would enable successful TB/HIV integration, and argues that despite a number of programmatic, infrastructural and human resource challenges, with commitment from all stakeholders, successful integration is possible and will facilitate the achievement of the health Millennium Development Goals (MDGs).
The main findings from the document include:
- there is urgent need to put into place rigorous measures to integrate TB and HIV response globally, which can be achieved at various levels and using a number of approaches
- a number of programmatic, infrastructural, and human resource challenges must be addressed through strengthening the health systems
- communities can play an important role in supporting the integration of TB into HIV programs by tackling stigma and discrimination, offering support to people living with HIV and TB and strengthening community-based referrals, linkages and service provision of both TB and HIV.
The document details that TB/HIV integration can be achieved at various levels (national level, district and regional level, health facility level and at the community level) and through a number of approaches. For instance at the health facility level, among other collaborative activities, the following offer unique opportunities for integration and have some overlap with WHO-recommended TB / HIV collaborative activities:
- testing all TB patients for HIV
- screening all HIV patients for TB
- providing antiretroviral therapy early in patients with TB
- provision of Isoniazid Preventive Therapy for PLHIV (people living with HIV) at high risk of TB
- provision of Cotrimoxazole Prophylaxis Therapy to HIV positive TB patients
- physical proximity of TB and HIV service delivery points.
Available online at: http://www.eldis.org/cf/rdr/?doc=57652
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Tuberculosis control has failed in South Africa: time to reappraise strategy
Authors: Wood,R.; Lawn,S.D.; Johnstone-Robertson,S.; Bekker,L.G.
Produced by: South African Medical Journal (2011)
This article looks at the reasons for the failure of South Africa’s current tuberculosis (TB) control programme by looking at the major drivers of the TB epidemic. The authors also identify new control strategies that they argue must be accompanied by novel TB control targets.
South Africa’s rate of TB has increased over the last 20 years, and in 2011 had the third-highest TB burden in the world. The TB control programme has primarily focused on effective case management of passively presenting TB cases, and progress has been recorded towards international treatment targets. While outcomes for notified TB cases have improved, this strategy failed to contain the TB epidemic, as illustrated with the data in this paper. While effective TB case management is necessary in TB control, it was, however, insufficient for TB control in scenarios such as South Africa with a high force of infection, high proportion of latently infected individuals and a generalised HIV epidemic.
The article makes the following recommendations for the identification of new control strategies:
- the benefits of improved case-finding depend on the prevailing epidemiology of TB transmission
- reducing the time period of infectiousness also directly influences the prevalence of infectious TB
- high-risk communities should be specifically targeted, and age specific interventions are necessary to interrupt TB transmission to infants and young children, school-age children and adolescents, and both HIV- negative and positive adult populations
- changing the emphasis from individual benefit to population benefit has parallels with the concept of using ART as prevention, which has been modelled as a potential strategy to control the HIV epidemic.
Available online at: http://www.eldis.org/cf/rdr/?doc=57646
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Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource constrained settings
Produced by: World Health Organization (2011)
These World Health Organization (WHO) guidelines provide guidance for national TB and AIDS programmes by updating existing WHO recommendations with new evidence, taking into consideration the changing context of HIV and TB prevention, treatment and care. The new guidelines focus on facilitating the implementation of isoniazid preventive therapy (IPT) and intensified case-finding (ICF). They are also intended to highlight and strengthen the leadership role of national AIDS programmes and HIV stakeholders to scale up the implementation of TB screening and provision of IPT among people living with HIV.
The document makes the following key recommendations:
- adults and adolescents living with HIV should be screened for TB and those who do not report any one of the symptoms are unlikely to have active TB and should be offered IPT
- adults and adolescents living with HIV and screened, and who report any one of the symptoms may have active TB and should be evaluated for TB and other diseases
- adults and adolescents living with HIV who have an unknown or positive TST status and are unlikely to have active TB should receive at least six months of IPT as part of a comprehensive package of HIV care
- adults and adolescents living with HIV who have an unknown or positive TST status and who are unlikely to have active TB should receive at least 36 months of IPT
- TST is not a requirement for initiating IPT in people living with HIV
- people living with HIV who have a positive TST benefit more from IPT; TST can be used where feasible to identify such individuals
- providing IPT to people living with HIV does not increase the risk of developing isoniazid (INH)-resistant TB
- children living with HIV who do not have poor weight gain, fever or current cough are unlikely to have active TB
- children living with HIV who have any symptoms may have TB and should be evaluated for TB and other conditions. If the evaluation shows no TB, such children should be offered IPT regardless of their age
- children living with HIV who are more than 12 months of age and who are unlikely to have active TB on symptom-based screening, and have no contact with a TB case should receive six months of IPT (10 mg/kg/ day) as part of a comprehensive package of HIV prevention and care services
- in children living with HIV who are less than 12 months of age, only those children who have contact with a TB case and who are evaluated for TB (using investigations) should receive six months of IPT if the evaluation shows no TB disease
- all children living with HIV who have successfully completed treatment for TB disease should receive INH for an additional six months.
Available online at: http://www.eldis.org/cf/rdr/?doc=57644
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Supporting community based responses to AIDS, TB and malaria: a guidance tool for including Community Systems Strengthening in Global Fund proposals
Produced by: Joint United Nations Programme on HIV/AIDS (2010)
This tool seeks to increase understanding about the benefits Community Systems Strengthening (CSS) can bring at the national, district and local levels, and to support advocacy and technical support efforts around CSS. It provides practical guidance on developing CSS activities for Global Fund proposals, advocating for the inclusion of CSS in national and regional proposals, as well as suggesting ways to more effectively implementing CSS activities if the proposal is approved.
Those likely to benefit from this guidance include staff in UNAIDS Country Offices and members of key affected populations, CBOs, networks of people living with HIV (PLHIV), CCM members, Global Fund technical review panel (TRP) members, international and national NGOs and faith- based organisations, other UN staff and proposal writing consultants.
The document contains sections on:
- roadmap: including CSS in a Global Fund proposal
- who needs to be involved, and what are their roles?
- community Systems Strengthening: activities and models
- assessing community-level needs within the national context
- the Global Fund Proposal Form and Guidelines
Available online at: http://www.eldis.org/cf/rdr/?doc=57641
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