A Guide to Hopebuilding Stories

Categorizing these stories (362 as of Oct. 10, 2008) is often challenging, because many of them talk about people's or community activities that addressed a number of issues at once, or grew from one small project into something much larger. Reflecting this, some stories appear in several categories. Clicking on the links highlighted in blue will take you to that page. Please do read my GuidelinesForSharing before you post.

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Co-operation between HIV/AIDS and TB programs can save thousands of lives

Co-operation between tuberculosis and HIV/AIDS treatments programs could save many lives. Alasdair Reid, HIV/TB adviser for UNAIDS, says all people living with TB should be offered HIV tests and access to antiretroviral drugs and all HIV positive people should be regularly screened for TB and provided with the preventive drug isoniazid. These lifesaving activities are cheap, simple and readily available in most countries, Reid told the 38th Union World Conference on Lung Health in Cape Town, South Africa, in mid-November.

"In 2005, only seven percent of HIV patients worldwide were tested for TB. That is shocking. By testing people living with HIV for TB we can save thousands and thousands of lives each year. And, it is feasible. The problem is the lack of co-operation between the different organisations that deal with TB or HIV." A new model for distribution of funds is also required, he said. "Currently, money is raised for either HIV or TB, and funds dedicated for HIV can't be used for TB or vice versa."

Active TB is highly contagious and although treatable, potentially deadly -- especially for AIDS patients. World Health Organization statistics show that 90% of people living with HIV/AIDS in Africa die within months of contracting TB. An estimated 590,000 people die of TB each year in Africa, the only continent where TB rates are rapidly increasing, and in some African countries, 75 to 80% of people living with TB are co-infected with HIV.

The conference organizer, an international coalition named the Union Against Tuberculosis and Lung Disease, has proposed a program called "Integrated Care for TB Patients Living with HIV/AIDS" to simultaneously address both diseases through increased collaboration and testing. The strategy is being tested in various countries, including the Democratic Republic of Congo, Uganda and Zimbabwe, and seems to be having positive results. Since 2005, there has been a threefold increase in the number of HIV-positive people screened for TB and a sixfold increase in TB patients tested for HIV.

Winstone Zulu, a Zambian activist living with HIV/AIDS, told the conference that it is time for organisations to work together. "One needs to understand that in Africa, people are not dying because of HIV or AIDS," he said. "I contracted TB in 1996 and it was truly the only disease in my entire life that nearly killed me. I have been living with HIV for 17 years and I have always been fine, due to the anti-retroviral treatment that I am taking. This all changed when TB hit me.” He received treatment in time and felt much better after a few weeks; four of his brothers, however, were not so lucky.

Doctors writing in the e-journal of the International AIDS Society earlier this year note that this separation of TB and HIV/AIDS often extends through the whole health care system. While greater resources in the health care system can compensate for this divided mandate within developed countries, care of co-infected patients in resource-limited countries is “often fragmented, uncoordinated, and unsuccessful.:

As both programs are often led from within national ministries of health, they can play a crucial role in encouraging a co-ordinated approach, the doctors say, citing Rwanda as an excellent example of such collaboration at the central level. Rwanda is implementing TB screening during enrolment into HIV care and treatment programs and at follow-up visits using simple symptom questionnaires, and some programs, such as Malawi’s, have already begun to adopt the public health-oriented strategies of TB care in newly developed HIV treatment programs. These examples provide models for other countries, they suggest.

WHO's new "Stop TB" strategy emphasizes the importance of addressing TB/HIV co-infection, and projects in Haiti, Rwanda, and rural KwaZulu-Natal in South Africa show that this is effective, while highlighting the technical, programmatic, staffing and scale-up challenges that remain. One of the challenges, of finding enough trained health care workers, could be met by using a community care model supported by non-professional health care workers drawn from community or family members, the doctors suggest.

This story is adapted from a report on the Cape Town congress entitled "Global Challenges | HIV/AIDS, TB Programs Must Cooperate To Save Lives, Health Officials Say", Nov. 12, 2007, and an article entitled "Tuberculosis and HIV--Needed: A New Paradigm for the Control and Management of Linked Epidemics" written by Simon J. Tsiouris, MD, MPH (corresponding author); Neel R. Gandhi, MD; Wafaa M. El-Sadr, MD, MPH; Gerald Friedland, MD, published in eJIAS: eJournal of the International AIDS Society and posted 9/25/2007 in Medscape General Medicine, 2007;9(3):62.

For other stories relating to TB diagnosis and treatment, see:

‘Integrating TB and HIV treatment and care saves lives’, South African study finds

Acupuncturists bring healing, relief, local training across the globe

Rats sniff out land mines, tuberculosis in Africa