TB and HIV: Five interventions we need
A key advocacy issue that TAC will focus on going forward is TB. TB has historically been one of South Africa’s largest health problems, especially in the mines and poor communities. This has been further exacerbated by the HIV epidemic. HIV-related TB is the leading cause of death in South Africa. Recorded TB deaths have increased from 25,640 in 1997 to 73,903 in 2005. Of particular concern is drug-resistant TB. We will be campaigning for the following five interventions:
- Protection of isolated TB patients: Patients with drug-resistant TB who are isolated have their social grants cancelled. This frequently leaves their families out-of-pocket. It is one of the reasons why isolated patients resist isolation.
- Earlier initiation of antiretroviral treatment for people with HIV: It is estimated that antiretroviral treatment reduces the risk of active TB by over 50%.
- Isoniazid Prevention Therapy (IPT) for all HIV-positive people. It is estimated that IPT reduces the risk of TB by just under 70%. Together, IPT and antiretroviral treatment reduce the risk of TB by over 75%.
- Improved Infection Control: There are many examples of how this can be done. A key example is this one: Many people contract TB, including drug-resistant TB, in health facilities. The Ubuntu Clinic in Khayelitsha has constructed an affordable waiting room that minimises this possibility. The Ubuntu waiting room should be replicated in TB facilities across the country.
- Intensified Case Finding: HIV testing and TB screening should be offered together in more facilities. People with HIV should be actively given the opportunity to screen regularly for TB, as should family members of people with TB. A recent issue of Science describes an extraordinary programme of active contact-tracing in Tomsk, Russia, using community health workers and implemented by Partners in Health. We should learn from these models.
For more information, see these key TAC TB documents:
- Prevention, Early Diagnosis, Treatment and Cure of Tuberculosis: A Guide and Recommendations for TAC, Government and Civil Society – TAC position paper Presented by Lesley Odendal at South African TB Conference, 3 July 2008
- Isoniazid Preventive Therapy in the context of HIV: An intervention that can save lives – TAC Position Paper on IPT
- Human Rights and TB: Time to demand Action – Presentation by Mark Heywood, Executive Director, AIDS Law Project, South African TB Conference, 3 July 2008