By Lucica Ditiu, Stop TB Partnership | Thu., December 1, 5:50 PM | Comments ( 0 )
Lucica Ditiu is Executive Secretary of Stop TB Partnership
On this World AIDS Day, when HIV programmes around the world are facing an era of significant financial constraint, it is a good moment to consider how to make the most of the resources we have for saving and improving the lives of people living with HIV. There is one highly cost-efficient intervention on which we are clearly failing to fully capitalize: preventing and treating tuberculosis (TB) – the number one killer of people living with HIV.
Important lessons can be learned from a small but growing number of HIV programmes that are demonstrating daily how simple it is to prevent TB deaths among people living with HIV and how little it costs. Take the Nyanga health clinic in Cape Town, South Africa.
Recently, Peta made her first visit to the HIV wellness centre at the clinic. She had tested positive for HIV a few weeks earlier.
Sister Fuzile, one of the centre's nurses, asks Peta about her living arrangements. How big is the space and how many people live there? Is there enough fresh air? These questions might seem tangential to management of HIV, but the answers can guide life-or-death decisions.
Although Peta did not demonstrate the classic symptoms of TB, Sister Fuzile considered her at high risk. TB takes the lives of one in four people living with HIV and is rampant in South Africa, especially among people who, like Peta, live under crowded conditions.
Sister Fuzile sent Peta for TB testing straight away. If the test comes back positive she will start TB treatment immediately, with an excellent chance of being cured after six months. Without treatment TB can be fatal in a matter of weeks.
The Nyanga centre is using a formula that works. You can save the lives of people living with HIV by getting answers to a short list of questions, providing a TB test if the answers indicate risk, and providing TB treatment to people who have a positive TB test. If people test negative but are at risk, give them a cheap preventive treatment.
A scientific model produced earlier this year by the Stop TB Partnership, World Health Organization and UNAIDS shows that if countries around the world scaled up these practices, we could prevent a million TB deaths among people living with HIV by 2015.
Yet too few health programmes in places where both HIV and TB are prevalent are taking these steps - even though TB can be diagnosed and cured for as little as $100 in most countries. If that does not change, people with HIV—even those receiving ART—will continue to die of TB. More than a million and a half will die by the end of 2015.
Although TB prevention and treatment are inexpensive, it is unlikely we can achieve the save a million goal without new financial commitments. Last week, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it was cancelling its plans to offer a new round of grants because of drastically lowered donor commitments. This could spell disaster for HIV, TB and TB/HIV programmes. We do not believe the world will stand by and allow the enormous progress made to date on the HIV pandemic to be reversed. New donors must and will step up to the plate. Countries with fast-growing economies - especially those that themselves have a high burden of HIV and TB - have a special responsibility to commit more funds to fight HIV and TB, both at home and abroad.
Let us not squander the huge investment the world has made in the health of people living with HIV by losing them to TB, a curable illness. Zero TB deaths among people living with HIV is an achievable goal - if not in our lifetimes, then surely in our children's lifetimes.
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