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Everyone has a role to play in addressing TB and HIV
Lois Chingandu, Southern Africa AIDS Information Dissemination Service (SAfAIDS)
March 23, 2007

This Saturday - 24 March- we will once again commemorate World TB Day - this year under the international theme, "TB Anywhere is TB Everywhere".

Tuberculosis (TB), an ancient disease dating back to the era of the Egyptian pharaohs, is today a global health problem affecting over 2 billion people. Despite over 40 years of TB treatment, the disease records an estimated 2 million annual deaths and is the leading cause of death among all of the world's known curable infectious diseases. Up to 1980, successful interventions had reduced TB to a manageable infectious disease. However, increased poverty, flagging health systems and the growth of the HIV epidemic have allowed for the silent yet lethal re-emergence of the TB epidemic.

The persistence of TB, even though we know how to manage it, is a reflection of the general complacency that now exists in fighting the disease. And we must accept that we will never be able to control TB, until we address the issue of poverty, especially in southern Africa, which has 11 of the 15 nations with the highest estimated per capita TB incidence rates. Despite the increase in the global economy over the years, most of the world's population, particularly in sub-Saharan Africa, has remained poor and without access to basic necessities such as food, water, sanitation and medical facilities. TB and its main infection ally, HIV, are not only rampant in such areas, but also their treatment is more difficult as both conditions require a patient to have healthy nutritious meals with their medication - something which is impossible for the many who cannot even afford one decent daily meal.

It is therefore impossible and impractical for us to believe that we can eradicate, or even halve TB infections by 2015 - as current global targets spell out - unless we begin to implement global and national strategies to contribute to meaningful and worthwhile poverty reduction programmes in Africa. If we do not, then we will continue to observe the growth of the phenomenon of drug-resistant strains of TB, which currently account for 10% of all new TB infections, and cost far much more to treat. The recent emergence of multi-drug resistant (MDR) and extremely drug-resistant (XDR) strains of TB, in the East and South Africa's Kwazulu Natal province respectively, serve to remind us that current tools used in controlling and monitoring TB and its co-infection process with HIV are inadequate to address the severity of the epidemics.

What we need is scientific progress in the field of this research, and not mere knowledge acquisition. Progress needs to come through testing interventions that will help in diagnosing and treating this drug resistance - something that is not possible with the TB smear tests that currently exist. We further demand progress in carrying out large scale and extensive research into TB drug resistance throughout the world, as has been conducted by the World Health Organization (WHO) and the United States Centers for Disease Control (CDC). Subsequent studies have been conducted in KwaZulu Natal, South Africa.

While studies into TB drug resistance have been conducted in Lesotho, Swaziland, Botswana and Zambia, the sample sizes were relatively small due in part to the lack of laboratory capacity in these resource-limited areas. Before we can hope to roll out treatment in the region, we must first gauge its nations' capacity to diagnose those in need of it. We must therefore produce assessment reports to support TB programmes, just as we have done to assess the capacity of laboratories in the region to support the scaling up towards universal access to HIV and AIDS prevention, treatment, care and support services. And we must continue with our advocacy calls for TB vaccine research and trials, while developing treatment that will work harmoniously with anti-retroviral drugs (ARVs) in light of the linkages between TB and HIV infection.

While there is good understanding among policy makers of these linkages, there is still limited integration of the two services, and weakened coordination between HIV and TB responses at operational level. The service providers, who have the responsibility to make the integration possible, either lack the knowledge about the linkages, or have insufficient training in dealing with TB and HIV co-infection. On this important day, we call upon policy makers to invest in extensive training of service providers, to operationalise the integration of services, and strengthen the coordination of TB and HIV and AIDS responses at all levels. For the future, we envisage a one-stop service for integrated TB and HIV testing, which would further cut on spending of already limited resources for the many who are coinfected with TB and HIV.

SAfAIDS commits itself to step up its information dissemination role through the roll out of an extensive programme to increase knowledge on HIV and TB co-infection, and to address the double stigma and discrimination suffered by people living with the two conditions. We also understand that drug resistance is in part being driven by a lack of awareness, among patients, about how to take TB treatment correctly and consistently for the usual 6-8 month period in which it is necessary, and that only through a community - based approach to the problem can we address such issues to do with drug adherence and compliance. We commit to continuing to inform not only individuals, but also their communities about TB and HIV diagnostic and treatment services. The importance of treatment supporters to assist in reminding patients to take their drugs on time is an intervention whose importance we have previously highlighted in our training package for community-based volunteers, which we devised last year in collaboration with the World Health Organization (WHO) and the International Federation of Red Cross and Red Crescent Societies (IFRC).

As SAfAIDS, we further add to this year's theme by declaring "TB anywhere is TB everywhere - Everyone has a role to play!" We say this because we believe that now is not the time to be passive about this disease. For if we are, we will relegate more people, particularly those co-infected with TB and HIV who number 13 million of the 40 million people living with HIV and AIDS worldwide, to unnecessary death. As such, we urge the Global Fund to fight HIV, TB and Malaria to increase funding for integrated programming for HIV and TB, while we encourage the Stop TB partnership to intensify its leadership role to support implementation of a comprehensive TB strategy which includes research into HIV and TB, in all its strains, and to provide financial support to smaller groups, as well as civil society for funding advocacy and social mobilisation activities at the grass roots level.

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