CDC's HIV/AIDS Care and Treatment Programs in South Africa:
TB and HIV
Integrating Prevention, Treatment and Care Services
TB fuels the HIV epidemic. It is only through developing integrated systems for diagnosing and treating HIV and TB will we be able to overcome the devastating effects of the dual epidemics in South Africa. Annatjie Peters, TB/HIV Specialist, CDC South Africa
WHO/UNAIDS estimates that one-third of the 40 million people living with HIV and AIDS worldwide are co-infected with tuberculosis (TB), one of the most common opportunistic infections. People infected with HIV are up to 50 times more likely to develop TB than HIV-negative people, and not surprisingly, TB is the leading cause of death among HIV-infected individuals, despite the fact that TB is curable.
South Africa s TB situation has reached a crisis point in several provinces. The country has one of the highest estimated TB rates in the world, ranking fourth among the 22 WHO-determined high-burden countries, with an estimated 461,000 new cases reported each year. The South African TB/HIV co-infection rate is also high, with approximately 55% of TB patients also testing positive for HIV. Further exacerbating the problem is the existence of drug-resistant TB, often caused by non-adherence to drug regimens.
For many years, attempts to tackle TB and HIV have been largely separate, despite the overlapping epidemiology. However, public health officials increasingly recognize that combined, coordinated efforts to address the dual epidemics are the only way to halt this dual epidemic, and the South African government has made a significant investment in TB control. South Africa s National Department of Health (NDOH) has created a five-year strategic plan for the National TB Programme (NTP), which highlights TB/HIV co-infection. Additionally, the National Strategic Plan for HIV & AIDS and STI, 2007 2011 (NSP) promotes integration of TB and HIV services as essential to ensuring that co-infected patients receive appropriate care and treatment.
The CDC South Africa, through its Global AIDS Program (GAP), is working hand-in-hand with the NDOH to support this integration of services. CDC South Africa supports the scaling-up of South Africa s TB/HIV efforts by:
- Improving planning, coordination, development, and implementation at all levels
- Assisting in the development and enforcement of technical guidelines
- Supporting efforts to raise awareness of the existence of TB/HIV co-infection and the ways through which it can be prevented
- Supporting the development and implementation of effective HIV counseling and testing methods in TB treatment settings, as well as methods to screen for
and diagnose TB in HIV testing and care settings
- Increasing access to Isoniazid (INH) preventive therapy for those patients who are HIV-positive and do not have TB
- Increasing access to HIV care and treatment services for those TB patients who are HIV-positive
- Aiding in implementation of basic TB infection control in HIV care and treatment settings
- Improving prevention, detection, and management of multidrugresistant (MDR) and extensively drug-resistant (XDR) TB in HIV-infected patients
- Strengthening surveillance efforts, laboratory services, and referral networks
- Strengthening health systems to ensure equality and sustainable care
CDC South Africa works in partnership with local organizations that collaborate on TB/HIV activities. Partners include:
- CAPRISA (Centre for the AIDS Programme of Research in South Africa undertakes globally relevant and locally applicable research which contributes to the understanding of HIV pathology, prevention and epidemiology, as well as examines the strong and potentially fatal linkage between HIV and TB.
- Council for Scientific and Industrial Research (CSIR) trains healthcare workers on infection control practices.
- TB/HIV Care Association aims to improve TB management by increasing access to TB and HIV diagnosis, care, treatment and community-
based adherence support.
- Desmond Tutu TB Centre at Stellenbosch University builds capacity through training and education.
- (Tuberculosis, HIV, Aids, Treatment Support and Integrated Therapy) provides integrated TB/HIV screening and clinic and support services in underserved areas.
- Wamtech Uses their software, the Electronic TB Register (ETR.Net) to help provide for more efficient and useful collection, compilation, and analysis of TB data on an ongoing basis.
CDC South Africa works closely with the NDOH and several implementing partners to develop policies, build capacity of service providers, and strengthen local health systems. Training and collaboration are emphasized to ensure skill retention and sustainability. The public and private sectors work collaboratively in South Africa to capture best practices and to ensure that these practices support policy development. Increased emphasis on strengthening management systems will also help to sustain gains made in the area of TB/HIV.
South Africa s dual TB and HIV epidemics are fueled by issues of poverty and limited access to counseling, testing, treatment, support, and laboratory services. Meeting these challenges is key to decreasing co-infection rates. Through close collaboration between CDC South Africa, its partners, and the NDOH, strides are being made to strengthen TB/HIV services to improve the health of South Africans.