TUBERCULOSIS: China takes action against tuberculosis and HIV co-infection

On Aug 3, the Chinese Ministry of Health released a comprehensive national implementation scheme for the prevention and control of tuberculosis and HIV co-infection. Tuberculosis and HIV co-infection has become a huge public health problem in China, which has the world's second largest tuberculosis burden with more than 1·3 million new cases diagnosed every year. Tuberculosis was the leading cause of death from an infectious disease in China until 2008, when HIV/AIDS took over. According to the Chinese Ministry of Health and UNAIDS, there were an estimated 560 000—920 000 people infected with HIV in China by 2009.
The new strategy encourages collaboration between those who care for people with tuberculosis and those who specialise in HIV. For example, patients diagnosed with HIV/AIDS should have sputum cytology, chest radiography, and tuberculosis screening questionnaires. Likewise, people newly diagnosed with tuberculosis should be offered HIV-antibody tests. Co-infected patients will receive free treatment and follow-up services.
Better integration of tuberculosis and HIV services is urgently needed in China's health-care system reform. However, there are problems that the current proposals do not address. There is no strategy for particular at-risk groups, such as migrant workers with limited access to diagnosis and treatment, and people with drug-resistant tuberculosis. There is also a shortage of staff capable of providing prevention services and effective treatment to people co-infected with tuberculosis and HIV. Additionally, patients' adherence to tuberculosis or HIV treatment is problematic because of extra fees not covered by the programme, and social stigma that can result in concealment of the illness and discontinuation of treatment.
The national implementation scheme is an important first step to address the problem of tuberculosis and HIV co-infection in China. To be more effective, it needs to be implemented and monitored actively, and to take the financial and social circumstances of at-risk groups into account.
http://www.thelancet.com/journals/lancet/article/PIIS0140673610612354/fulltext?rss=yes