By World Health Organisation /Stop TB Partnership /Damien Schumann | Thu., December 1, 10:18 AM | Comments ( 3 )
Zanele, from the Nyanga township in Cape Town, is living with HIV. Thanks to antiretroviral therapy (ART), she will be able to lead a full life and look after her baby girl Lilathi. But living with HIV also makes her 20 to 30 times more vulnerable to tuberculosis (TB), and she became ill with the disease one month ago. TB is responsible for one in four AIDS deaths and the co-epidemic is particularly devastating in Africa.
Left untreated, TB is deadly. People living with HIV can die from the disease within weeks. Programmes that integrate TB and HIV services can provide a better chance of being tested and treated for TB before it's too late for people like Zanele. Here at the Nyanga clinic in Cape Town, Sister Fuzile welcomes patients to her HIV wellness clinic, where she will also carry out TB screening. The clinic is busy so windows and doors are kept open to improve ventilation stop the transmission of TB.
Sister Fuzile takes blood to check a patient's CD4 count, a measure of how well the body is dealing with the HIV virus. At the same time she checks for TB symptoms and risk factors such as living in cramped, poorly ventilated accommodation. High risk patients and those with symptoms are sent to the TB department immediately. If they test positive for TB, they start treatment straight away.
Scientific modelling, produced by the Stop TB Partnership, WHO and UNAIDS, shows how massive scaling up of existing activities, such as those carried out at Nyanga, could prevent a million TB deaths among people living with HIV by 2015. The needed activities include scaling up clinic services and reaching out further into communities with TB and HIV interventions. Here a health worker from the Desmond Tutu TB Center goes from door to door offering HIV testing and TB screening.
Zanele takes her TB drugs at the Nyanga clinic. She started treatment as soon as she was diagnosed with TB. One month later she is showing signs of improvement and is no longer likely to pass on the disease to others.
Mkluli is living proof that HIV positive people can lead productive lives while on TB treatment. He was diagnosed with multidrug-resistant TB 2 years ago and is coming to the end of the long treatment process. Taking ART and TB treatment at the same time is difficult and makes him feel tired. Despite this, he has been able to continue his work at the Yizane Sakle NGO which supports the social development of orphans and vulnerable children.
Fundiswa is also taking TB treatment as well as ART. She finds it difficult to take the pills and often feels tired, but she is able to continue her work as a cleaner. Today she is cooking dinner for her two sisters and her 14-year-old daughter. Maintaining a healthy diet helps patients digest their pills and fight off TB, so local clinics and NGOs provide food parcels to patients.
Zaneli's baby daughter Lilathi is also HIV-positive. In places where TB and HIV are prevalent, children living with HIV are highly vulnerable to becoming ill with and dying from TB. In addition, when women living with HIV develop TB during pregnancy they are more likely to transmit HIV to their unborn children. Their cramped accommodation—Zaneli and Lilathi sleep on the kitchen floor—increases the risk of passing on TB.
. The clinic has asked Zanele to bring Lilathi in for a TB test. At 6 a.m. they set off for the short walk through the township. The early start and cold weather are off-putting but Zanele is determined to get her baby tested
Children have difficulty coughing up the sputum needed for a TB test, so health workers have to use other methods to make the diagnosis. At the clinic, Lilathi is given a tuberculin skin test (TPT) test. The test cannot tell whether she has active TB but it confirms that she has been infected with the bacteria. That, and the fact that she had been in contact with Zanele, convince the doctors to give her preventive treatment with the drug isoniazid.
For Zanele and Lilathi, the fight is not over. They will have to stick to their clinic appointments and keep taking their medication. But thanks to the integrated TB and HIV services provided in Nyanga they both have the chance to lead fulfilling lives. Without these services, Zanele's TB could have been ignored in the shadow of HIV.
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