|
The Human Immunodeficiency Virus (HIV) pandemic presents a massive
challenge to the control of tuberculosis (TB) at all levels.
Tuberculosis is also one of the most common causes of morbidity and
one of the leading causes of mortality in people living with
HIV/AIDS (PLWHA).
This policy responds to a demand from countries for immediate
guidance on which collaborative TB/HIV activities to implement and
under what circumstances.
This policy does not call for the institution of a new specialist or
independent disease control programme. It rather promotes enhanced
collaboration between tuberculosis and
HIV/AIDS programmes in the provision of a continuum of quality care
at service-delivery level for people with, or at risk of
tuberculosis and people living with HIV/AIDS.
The policy goal is to decrease the burden of tuberculosis and HIV in
populations affected by both diseases.
The objectives of collaborative TB/HIV activities are:
(1) To establish the mechanisms for collaboration between
tuberculosis and HIV/AIDS programmes.
(2) To decrease the burden of tuberculosis in people living with
HIV/AIDS.
(3) To decrease the burden of HIV in tuberculosis patients.
The policy recommends setting up of coordinating bodies for TB/HIV
activities effective at all levels. It says that so far even in
settings where HIV prevalence is high, tuberculosis and HIV/AIDS
programmes have largely pursued separate courses. TB/HIV
coordinating bodies are needed to ensure more effective
collaboration between existing HIV/AIDS and tuberculosis programme
efforts at all levels.
The policy also advises nations to conduct surveillance of HIV
prevalence among tuberculosis patients.
There are three key methods for surveillance of HIV among
tuberculosis patients:
1. Periodic surveys (cross-sectional HIV seroprevalence surveys
among a small representative group of tuberculosis patients within a
country)
2. Sentinel surveys (using tuberculosis patients as a sentinel group
within the general HIV sentinel surveillance system)
3. Collection of data from the routine HIV testing and counselling
of tuberculosis patients.
The policy makes following recommendations in this regard:
1. There should be HIV surveillance among tuberculosis patients in
all countries irrespective of national adult HIV prevalence rates.
2. Countries with unknown HIV prevalence rates among tuberculosis
patients should conduct a seroprevalence (periodic or sentinel)
survey to assess the situation.
3. In countries with a generalized epidemic state, HIV testing and
counselling for all tuberculosis patients should form the basis of
surveillance. If this is not yet in place, then periodic surveys or
sentinel surveys are suitable alternatives.
Recommendations
1. HIV testing and counselling should be offered to all tuberculosis
patients in settings where the HIV prevalence among tuberculosis
patients exceeds 5%.
2. Tuberculosis control programmes should mainstream provision of
HIV testing and counselling in their operations or establish a
referral linkage with the HIV/AIDS programmes to do so.
The "3 by 5" Initiative aimed at treating 3 million people with ART
by 2005 will enhance ART access to eligible TB patients.
The following are global targets for collaborative TB/HIV
activities:
By 2005, all countries in Category I and Category II establish at
least a national TB/HIV coordinating body to create the mechanism
for collaboration between tuberculosis and HIV programmes.
By 2007 all countries in Category I and
Category II develop joint TB/HIV implementation plans.
By 2007, all countries in Category I and
Category II establish a system for HIV surveillance among
tuberculosis patients.
Get the tool:
http://www.who.int/gtb/publications/tb_hiv/2004_330/pdf/interim_policy.pdf
|
