Zambia's fight against HIV/AIDS hampered by TB

Violet Mengo

The Daily Mail, Zambia

IT IS NOT ZAMBIA ALONE BUT MANY OTHER COUNTRIES ALSO ARE IN A SIMILAR SITUATION OF DIFFICULTIES WITH TB HIV CO-INFECTION"


Zambia's fight against HIV/AIDS is being hampered by the preventable and curable disease - tuberculosis (TB).

Efforts to address this challenge has resulted in a global meeting scheduled for New York where government, public health and business leaders, heads of UN agencies and advocates will acknowledge HIV/TB as an urgent priority. VIOLET MENGO reports.

THE first ever HIV/TB Global Leaders' Forum, convened by Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB, seeks to galvanize leadership at all levels in curbing the scourge.

At this meeting Dr Sampaio is expected to report back to the UN General Assembly High-Level meeting on AIDS which would take place a day after the leaders' forum on the results of the HIV/TB Global Leaders' Forum. It will be a call to action.

This is against a background of calls for bold leadership at all levels to cut the number of deaths from TB among people living with HIV in the world.

With the emergence of drug resistant strains of TB, which are particularly lethal in populations with high rates of HIV infection, HIV/TB has become a global security issue.

It is also believed that drugs, diagnostics and vaccines currently available are not appropriate for people with HIV/TB co-infection. The call is for new tools that work in the presence of co-infection.

HIV and TB are major constraints for socio-economic development and investing in joint TB and HIV/AIDS interventions would strengthen health systems and contribute to the achievement of the Millennium Development Goals on poverty reduction by keeping people healthy and productive.

The leaders' forum provides a platform on which to ensure that HIV/TB prevention and treatment is secure.

It is expected that leaders at the forum will take the opportunity to reaffirm their commitment to addressing this dual threat.

Many countries in the world, and Africa in particular are making impressive gains in treating people living with HIV, but this investment and progress is squandered by TB.

Without proper treatment with anti-TB drugs, approximately 90 per cent of people living with HIV die within two to three months of becoming sick with TB, even if they are receiving anti-retroviral treatment.

Worldwide, nearly a quarter of a million people die from HIV/TB co-infection each year. This dual threat is a barrier to keeping people healthy and productive, and impacts poverty reduction plans and the broader development agenda.

The International Labour Organisation (ILO) reports that the HIV/AIDS epidemic has lowered the growth of gross domestic product (GDP) worldwide by US$25 billion per year.

A number of studies, including one released by the World Bank last month, have also found that the direct and indirect costs of inaction on HIV are far greater than the costs of treatment.

As for TB, a 2007 World Bank research report stated that countries heavily affected by TB could collect at least 9 times their investments in TB control.

In Zambia, TB incidences have greatly increased in the last 10 years. DOTS (Directly Observed Treatment Short Course), the internationally recommended TB control strategy that includes standardised case detection, treatment and patient support that requires consistent drug supply and effective monitoring systems is in place.

Zambia has adopted and implemented DOTS since 2000. Full national DOTS coverage was reportedly achieved at the end of 2006 with an estimated treatment success rate of 90 per cent.

But is it really time to focus on DOTS more intensively?

According to the World Health Organisation (WHO), drug resistant TB is a symptom of poor programme performance.

It is said that if it is hoped to change the outcome and decrease the proportion of drug resistant TB, the DOTS model should to be adapted or its implementation improved. More of the same might only compound the TB drug resistance threat.

Despite the recent DOTS coverage gains in Zambia, many communities in the rural areas are lagging due to a number of reasons.

Rural settings, poor communities and mobile populations, for example are subject to social and economic factors that often lead to incomplete or inappropriate treatment.

In addition, TB diagnosis is difficult in people living with HIV- a growing proportion of people with TB today.

Better strategies to make TB control programmes work more effectively for the most vulnerable and hard to reach communities are also essential to improving treatment adherence and as a consequence reducing drug resistance.

The Ministry of Health 2006 annual report highlights Multi Drug Resistant TB (MDR-TB) as having been encountered in Zambia and its presence in HIV programme.

MoH spokesperson Dr Canisius Banda said the ministry had continued to experience challenges in addressing HIV/TB.

He said the ministry was working on addressing the challenges of HIV/TB with help from partners.
"The challenge of HIV/TB challenges is being felt and efforts to address this problem were being addressed. It is not Zambia alone but many other countries also are in a similar situation of difficulties with co-infection. We are partnering with the private sector to expand service provision," Dr Banda said.

He said concerted efforts from higher levels were the best way of answering the challenge of co-infection in Zambia and the region as a whole.

Dr Banda called for effective TB treatment for those with TB and preventive therapy to those with the disease.

"A six months treatment costs less than US$20 while a preventive drug therapy costs US$2, an amount many Zambians can easily afford. Many people are not keen on prevention," he said.

In Zambia, progress remains slow on the more challenging front of detecting and treating TB among people cared for in HIV treatment settings.

Dr Banda said that 90 percent of people with TB were also HIV positive; he said this was very common in many patients in Zambia.

Zambia's HIV activist and a person living with HIV/AIDS Winstone Zulu urged the Government to help stop TB especially among people living with HIV.

Mr Zulu, who is also a TB Partnership Kochon Winner (2007), said it would be good to see a unified response to the challeng