Currently, we are able to diagnose only half of the PLHIV with TB. It is very important to get this unidentified population into healthcare systems. One way to do this is to promote integrated community based activities. We will have to raise awareness of community health workers, healthcare workers and community members, to be always suspicious of the other disease when they are dealing with one. Diagnosis for HIV as well as TB has to be scaled up as it will help us detect the remaining 50% of HIV associated TB cases.
CSOs should come forward to reinforce the public health importance of interaction between HIV, TB and NCDs and to ensure that governments take their responsibility seriously and integrate the WHO recommendations in their national programmes."
Dr Christopher Zishiri, Country Director (Zimbabwe), International Union Against TB and Lung Disease (The Union): "The high TB epidemic in Zimbabwe is largely driven by HIV. Our intervention plans are based on integration of HIV-TB services. The intervention is a one stop shop like a supermarket. We did a pilot in 2008 to see the feasibility of decentralisation of services in 3 high burden sites, which gave very encouraging results in terms of anti retroviral therapy (ART) uptake. Currently we are replicating this strategy in 23 more clinics. Due to integration, uptake of TB-HIV services has increased from 74% to 94%. Use of GeneXpert has reduced turn around time in diagnosis from 1 week to 24 hours. But some key challenges still remain--GeneXpert is yet to be rolled out in the whole country.
Zimbabwe's TB control programme is mostly funded by Global Fund and USAID. But we are engaging with our Parliamentarians in a big way to garner political support to increase government funding for taking forward the TB control programme."
Amy Israel, Programme Director for Lilly's Global Health Programmes: "The Lilly MDR-TB partnership focusses on China, India, Russia and South Africa and the Lilly Non-Communicable Diseases (NCD) partnership focusses on Brazil, Mexico, India and South Africa. We are trying to improve treatment outcomes closer to the primary care or community care through an operational framework called Research Report Advocate. Every model we support has research generated data based report that we advocate.
South Africa is one of the very high TB burden of, HIV, diabetes and hypertension. We are developing a model of integrated person centric care in which a person will have to go to just one clinic (and not 3 or 4) to be taken care of these diseases.
There is a need for linkages between public and private sector. In India many people go to the private sector as their first point of care, regardless of their economic status. So we are engaging with private pharmacists and some private hospitals for TB and diabetes care, and have seen treatment adherence rates increase to 95% in TB.
CSOs will have to work with local, provincial and national governments for implementing bi-directional screening of people for TB and diabetes. We are working with school children in Brazil, helping them and their parents to take better care of their type 1 diabetes. Schools offer good opportunity to educate parents and children both."
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