Learning From Experience: Five Specific Steps to Tackling Tuberculosis and HIV in 2019

I was treating a woman named Cindy who had just immigrated to the UK from a country where tuberculosis (TB) is endemic. She had started her first job as a nanny for two children. She came to see me, spitting blood, chest pains and a high fever. We diagnosed him with tuberculosis. She has also been tested positive.

When his employers learned about it, they fired him and, at the same time, his boyfriend left him. In a few weeks, Cindy's whole life was turned upside down: she had no money, no job, no where to live.

Cindy is one of the hundreds of patients I've treated with similar stories. In 2017, about 300,000 people living with HIV died of tuberculosis. Tuberculosis remains the leading cause of death for people living with HIV, with 80% of these deaths occurring in only eight countries (including seven in sub-Saharan Africa). In 2016, only 39% of people living with HIV who developed TB received treatment for HIV and TB. And only 42% of newly enrolled HIV patients received TB preventive treatment. In some countries, where HIV and TB are important public health issues, adequate diagnosis, treatment, care and support are provided. However, in other countries, much remains to be done.

If we are determined to stop TB among people living with HIV, we can take specific steps to do more this year to ensure that people like Cindy receive the quality care they are entitled to:

1. Strengthen integrated HIV and TB services: HIV and TB services must go hand in hand and must be delivered together. Although international treatment guidelines have long recognized the value of fully integrated services for HIV and TB, the integration of services remains far too rare. Instead of treating the whole person, the services often only meet a part of his needs. This can lead to late or undiagnosed diagnosis of TB and / or HIV, which can have a detrimental effect on the health and effectiveness of treatment for the individual. We need to intensify integration and ensure that new tools, including rapid diagnostic tools such as Xpert MTB / RIF and TB-LAM, are used. We need to consider and invest in differentiated models of service delivery that build community resilience to TB and HIV, and learn from positive examples. These models must respond to evidence-based practice of providing care and support to the diverse and specific needs of different groups, and taking into account their particular circumstances. Among them are children and adolescents or people living with HIV who are being treated for drug-resistant TB.
2. Reaching all who need treatment for latent TB: we must redouble our efforts to improve the reach, quality and effectiveness of TB prevention services. Urgent efforts are needed to intensify the treatment of people with latent TB infection, which will require enhanced screening services. Despite the fact that 1 million people living with HIV started the prevention of isoniazid TB in 2017, only half of the countries with the highest incidence of HIV-badociated TB did not report the initiation of HIV / AIDS. prevention of tuberculosis in persons treated. Innovations in this area are encouraging as new, more user-friendly formulations become a reality. The combinations of isoniazid and rifapentine (HP) can be used with the existing anti-HIV treatment pool. But now is the time to intensify innovations in countries while seeking to increase access to generic medicines.
3. Use the best treatment for drug-resistant TB: We need to ensure that programs offer the best options for TB treatment – preferred, safer, oral therapy regimens and new drugs, such as bedaquiline and delamanid. Progress has been made in the provision of pretomanid as it enters the priority study of the US Food and Drug Administration. These advances represent a unique opportunity to provide shorter, easier and less toxic treatments for those forms of TB that are more difficult to treat for the first time in 50 years.
4. Giving priority to finding a safe and more effective TB vaccine: this quest can potentially change the game. We call for more investment and inclusion of people living with HIV in clinical trials because This population will be critical to achieving the global HIV reduction goals. the burden of TB in contexts of high HIV prevalence.
5. Getting to the heart of the stigma of TB and HIV: we must do everything in our power to ensure empathy when we treat people with TB and HIV. It starts with how health facilities treat people with TB and HIV. We can not let stigma hinder the reception of people like Cindy, but rather ensure that everyone has access to the best and most comprehensive services they need, when they need it.

We have the opportunity to defend and advance these tangled measures to combat these related epidemics. In the coming months, the HIV / TB 2019 symposium will take place before the 10th IAS Conference on HIV Sciences (IAS 2019) in Mexico, which will focus on a new era of TB prevention and prevention. its implications for people living with HIV. This meeting will bring together researchers and practitioners from different areas related to TB and HIV to exchange knowledge and propose solutions that will enable all those in need to access holistic and patient-centered treatment. nobody. Later, the triennial replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria will be the main source of funding for TB services.

To beat TB, one of the most important things we can do to improve the health and well-being of people living with HIV. We must build on these two moments of 2019 to advocate for the political and financial support needed to make it a priority of the global agenda for health and development.

Today, Cindy is fully treated for TB and is on regular treatment for HIV. She is married and has a good job. We were able to put her in touch with social services and other support services. His case should not be the exception, but rather the norm. It is time to join forces and ensure that the human rights of people like Cindy, in the context of TB and HIV, are not compromised. It's time.

By Anton Pozniak, President of IAS

Source: IAS