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Developing countries, particularly those in Asia,
have for centuries borne the heavy burden of tuberculosis (TB). Of the eight million people developing TB
every year, nearly 40% live in the World Health Organizations South-East Asia
Region. It is no
surprise that even today TB is the leading infectious cause
of mortality among adults.
This major problem is now being further complicated by the
alarming spread of human immunodeficiency virus (HM and the emergence of drug resistance.
HIV not only makes the
diagnosis ofTB more difftcult; it
contributes to an increase in TB incidence. The rate of breakdown to clinical
TB in individuals infected both with
HIV and tuberculosis is many times higher than in those
without HIV. As a result, increases in TB attributed to HIV can be expected
wherever the HIV epidemic is severe. The burgeoning TB burden will, therefore,
overstretch the atreadyfragile health
infrastructure in the Region.
The problem of TB/HIV is an issue ofcritical
importance, which needs to be serious ty addressed
by all countries. Although the overall impact in the Region is not yet
substantially visible, a great challenge ties ahead for health programmes.
Innovative
approaches are required, particularly to reach the vulnerable
and socially marginalized populations most at riskfor
both infections. Experience shows that proper management of TB and care of
the patients can improve their survival and also enhance the quality of their
lives. Provision of care at the community level however requires measures
which counter
discrimination and enhance acceptance by the community of
people living with HIVIAIDS.
The close link between TB and HIV also requires enhanced collabora-tion and harmonization ofefforts
in order to prevent HIV and
to manage TB within theframework of
the comprehensive care continuum
from institution to community
and home. HIV and TB programmes must work in
collaboration to maximize their outputs from the limited resources available. Enhanced political
commitment,
integrating relevant activities in various programmes
and strengthening partnerships with governmental and nongovernmental sectors,
will help to meet the challenge posed by the dual epidemic and to support
the sustainability of efforts.
This document has been developed to provide an overview of this important problem as it relates to the
South-EastAsia
Region. It covers epidemiology, TB control strategies, management of HN-associated TB, and prevention of TB in the health care
setting. The information
provided will be useful for staff of national TB and AIDS control programmes,
NGOs, conununity- based organizations and health
professionals in both private and public sectors. I am sure that readers will find
this publication useful and informative.
Dr Uton Muchtar
Rafei
Regional Director 
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