Abstract

Integrating the care of HIV and TB in developing countries

Author(s): Robin Wood

National TB programs (NTP) in countries with high HIV prevalence have been confronted with increased TB case loads. The complexity of management of TB has been complicated by smear-negative extrapulmonary disease, high mortality and an association with drug-resistant TB. As a result of international funding, access to antiretroviral therapy (ART) has rapidly expanded. NTP and HIV/ART programs have developed separately and HIV/TB patients receive care in two programs, resulting in duplication of care, and missed treatment opportunities. Collaboration between the services has been successfully demonstrated at strategic levels, national surveillance and in small pilot projects at hospital and clinic level. However, streamlining of services alone will not restore TB control in high HIV prevalence settings. HIV/TB control will require both expanded TB program capacity to detect and treat TB cases earlier in order to decrease the infective pool, and HIV services will need to expand ART coverage to decrease the large pool of susceptible individuals in the population.