| South-East
Asia Regional Training Course on TB Control
NTI, Bangalore, India, 16-27 August 2004
TB/HIV EPIDEMIC
Facilitators: Dr Haileyesus Getahun,
WHO, Geneva
Dr Erwin Cooreman, WHO, SEARO
1. Introduction
HIV is the main
reason for failure to meet TB control targets in highly affected countries.
Although sub-Saharan Africa
bears the brunt of the HIV fuelled TB epidemic, other regions such as South
and Central Asia, and Eastern Europe are experiencing the fastest growing HIV
epidemics that could also increase the number of HIV-related TB cases. No
country in the world is spared of the threat or the scourge of HIV/AIDS and
the corresponding TB epidemic, which calls for appropriate timely measures. 2. Learning
objectives
 to
gain knowledge of the global epidemiology and efforts of the TB/HIV
epidemic;
to
understand the dynamics how the HIV/AIDS epidemic is fuelling the TB
epidemic;
to
gain knowledge of the contents of the HIV/TB Regional Strategy;
to
understand the recommendations of the Interim Policy on the
Collaborative TB/HIV Activities.
3. Contents
Implications of HIV/AIDS in TB control
Global efforts to control the intersecting
epidemics of TB and HIV
Regional Framework to control HIV/TB
TB/HIV Collaborative Activities and
recommendations of the Interim Policy
4. Summary
WHO's global
targets for the control of tuberculosis (TB) are to detect 70% of the
estimated cases and to treat 85% of them successfully by 2005. The Millennium
Development Goals embraces the 2005 WHO targets and also aim to halt and
begin reverse the incidence of TB by 2015. HIV is the main reason for failure
to meet tuberculosis control targets in highly HIV affected countries. HIV
promotes the progress of recent and latent Mycobacterium tuberculosis (MTB)
infection to active TB, as well as increasing the rate of recurrent TB. TB is
a major cause of death among people living with HIV/AIDS. In response to this
growing epidemic, the TB/HIV Working Group was established in 2001 under the
auspices of the Stop TB Partnership. It is constituted by representatives
from both the TB and HIV communities.
The establishment
of the TB/HIV Working Group has provided the mechanism for co-ordinating the
global response to the intersecting epidemics of TB and HIV, as part of
global DOTS expansion activities. The TB/HIV Working Group has developed the
“Strategic Framework to Decrease the Burden of TB/HIV” , to establish what
could be done to address the combined epidemics of TB and HIV, the
“Guidelines for the Implementation of Collaborative TB and HIV Programme
Activities”, to define how these things could be done, and a document
“Interim Policy on Collaborative TB/HIV Activities”, advising countries on
what should be done, under given circumstances.
Collaborative
TB/HIV activities have the objectives of creating a mechanism of
collaboration between TB and HIV/AIDS programmes, reducing the burden of TB
among people living with HIV/AIDS (PLWHA) and reducing the burden of HIV
among TB patients. They also provide opportunity for those countries with low
HIV prevalence to have continued vigilance to deter the TB/HIV epidemic. However, there is relatively slow progress in
the implementation of these collaborative TB/HIV activities in countries
highly affected by the intersecting epidemics of TB and HIV. Heightened
awareness of the importance of collaboration between the HIV/AIDS and TB
programmes and responding through national policies and implementation plans
to accelerate the implementation of joint activities are crucially needed for
improving the care for HIV infected TB patients in settings where HIV is
fanning the TB epidemic. In other settings of low HIV epidemic, continued
vigilance of the situation is crucial to avert the rage of the epidemic
timely. 5. Tools
PowerPoint presentation in an interactive
session with the participants;
Group work and presentations by participants
on the recommended collaborative TB/HIV activities.
6. Reference
materials
Regional
Strategic Plan on HIV/TB. WHO/SEA/TB/261&AIDS/140, 2003.
Interim
Policy on Collaborative TB/HIV Activities. WHO/HTM/TB/2004.330
WHO/HTM/HIV/2004.1. Geneva: WHO 2004.
Strategic
Framework to Decrease the Burden of TB/HIV. WHO/CDS/TB/2002.296
WHO/HIV_AIDS/2002.2. Geneva: WHO 2001.
WHO
TB/HIV A Clinical Manual (2nd edition in print)
Guidelines
for Implementing Collaborative TB and HIV Programme Activities.
WHO/CDS/TB/2003.319 WHO/HIV/2003.01. Geneva: WHO 2003.
Scaling
Up Antiretroviral Therapy in Resource-Limited Settings: Treatment
Guidelines for a Public Health Approach - 2003 Revision
Guidelines
for HIV Surveillance Among Tuberculosis Patients - Second Edition, 2004.
A
Guide for Monitoring and Evaluation for Collaborative TB/HIV Activities (in
preparation).
WHO/UNAIDS
Policy Statement on HIV testing and counseling.
|
