"We must focus upon individual human beings rather than on individual diseases of TB and HIV. A person-centric approach is bound to work better than a disease-centric approach," said Mark Dybul, Executive Director, Global Fund to fight AIDS, Tuberculosis and Malaria, at a high-level WHO consultation, held in conjunction with 20th International AIDS Conference (AIDS 2014), to discuss policies to catalyze the response for elimination of TB deaths among people living with HIV (PLHIV).
TB remains the leading cause of HIV-associated deaths, accounting for an estimated 320,000 HIV-related deaths in 2012. Fewer than half of the 1.1 million estimated HIV-positive incident TB cases were identified in 2012 with only 28% of estimated TB/HIV cases receiving anti-retro-viral therapy (ART). More than 80% of countries still do not report providing Isoniazid Preventive Therapy (IPT) to eligible PLHIV. The impact resulting from enormous investments made into HIV is being undermined by a disease that is both preventable and curable.
A conglomeration of policy makers, donor agencies, researchers, and civil-society advocates discussed the way forward for TB-HIV collaborative activities, which first started in 2004.
Gottfried Hirnschall of WHO favoured going beyond silos and moving from 'collaborative TB/HIV activities' to 'joint TB/HIV programming.' According to him, there must be joint-resource mobilization, programme planning and supervision; renewed political leadership and increased convergence between TB and HIV programme stakeholders at national and sub-national levels; greater focus on accelerated and tailored service delivery to expand coverage and optimize resources; and integrated monitoring and evaluation. This could help us scale up in a more rational and efficient manner.
Mark Dybul shared that, "It took the Global Fund to fight for 10 years to get collaborative HIV TB activities endorsed by countries after a lot of resistance. Now we are in a position to completely control (though not eradicate) these two infections through innovations in diagnostics and treatments; implementation tools for active case finding and ensuring quality control; and partnerships between different organizations. Not only TB and HIV but all public-health communities should come together for the common good of individual people suffering from one or multiple diseases. We cannot afford to separate the two diseases any longer."
Ambassador Deborah Birx, US Global AIDS Coordinator, insisted that integration of the two programmes are critical for saving lives. She found it incredibly unacceptable that even after 12 years of PEPFAR and Global Fund funding we are not able to provide ART to all PLHIV coinfected with TB. Our goal should be 100% coverage. She felt the need to engage all partners including communities and civil society to (i) generate reliable data to inform programmatic decisions to reach all eligible PLHIV coinfected with TB, (ii) rapid scale-up of combination prevention--ART+IPT (iii) improved coverage for neglected populations, (iv) promote one-stop-shop models for TB and HIV services, which also means that maternal-health clinics must diagnose HIV as well as TB in pregnant women and not make them access the two services at two different places. We also have a commitment to save mothers' and children's lives.
Anthony Fauci, Director National Institute of Allergy and Infectious Diseases (NIAID), elaborated upon the role of biomedical research in integrating TB/HIV programmes. Discovery by biomedical research of new and improved interventions can get into the bucket of implementation. NIAID funds a global network of 6 major HIV/AIDS clinical trials networks, three of which have been expanded to include both TB and TB/HIV, with a view to support research for fighting the dual epidemic of TB and HIV.
Dr Fauci explained that key HIV/AIDS-TB research areas include better understanding of TB pathogenesis; new TB diagnostics which are point of care, simple, accurate and inexpensive and which can detect TB in clinical specimens from multiple body sites; improved TB therapeutics with shorter and simpler treatment regimens having fewer side effects and no drug-drug interactions with ARVs; and TB-prevention tools like safe and effective vaccines against all forms of TB.
Lucy Cheshire of TB Advocacy Consortium told Citizen News Service (CNS) that she was confident, civil society in collaboration with governments and donors, can take up the challenge to scale up TB-HIV collaborative activities in order to have a world free of TB and HIV.
Peter Godfrey Faussett of UNAIDS beautifully summed up the consultation by underlining the importance of going beyond just scale up of ART in PLHIV coinfected with TB and finding and treating HIV-negative people with TB quickly and early, as they are often the ones who are the source of TB infection to those living with HIV.
Let us hope that the ideas shared at the consultation will lead to an evidence-based, rights-based and gender-transformative response to HIV/AIDS, TB and effective public health programmes for all, irrespective of gender, age, race, ethnicity, religious or spiritual beliefs, sexual orientation and gender identity as envisaged in the Melbourne Declaration.
Shobha Shukla, CNS
(The author is the Managing Editor of CNS. She is reporting from the XX International AIDS Conference (AIDS 2014) with support from the World Health Organization (WHO) Global Tuberculosis Programme. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email: firstname.lastname@example.org, website: www.citizen-news.org)
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