TUBERCULOSIS: China details plan to fight co-infection of HIV and TB

BEIJING, Aug. 3 (Xinhua) -- China's Health Ministry Tuesday detailed a plan to fight co-infection of HIV and tuberculosis (TB).
A ministry circular to health authorities across China said tuberculosis infection had become one of the leading causes of death among people living with HIV.
People living with HIV whose immune systems were compromised by the virus are more likely to contract TB, and even die of it.
The number of cases of co-infection was still unknown.
The ministry ordered HIV/AIDS prevention and control authorities nationwide and those responsible for TB to step up cooperation in data sharing and testing.
The ministry ordered free treatment and follow-up visits to patients co-infected with HIV and TB once detected.
It required HIV/AIDS prevention authorities to annually provide at least one TB examination to people with HIV or AIDS patients.

MALARIA: Rwanda: Top down targets and donor-set priorities

The Rwandan government says that the main problem in making better use of existing resources is the development partners.13 In 2006,Rwanda had "$18m earmarked for malaria (the biggest cause of mortality and morbidity) and just $1m for the integrated management ofchildhood illnesses, compared to $47m for HIV/AIDS, grossly disproportionate in a country with a 3% infection rate." The emphasis on HIVmeans that: "physicians employed by NGOs to deliver HIV/AIDS services [are] paid almost six times as much as physicians paid by the[Ministry]. Such differences in salaries make it particularly challenging to keep well qualified health personnel in the public sector."The 2006 government analysis showed that an extra $20 per person could reduce maternal and child mortality to meet internationaltargets. The first $9 were "estimated to deliver three quarters of the reduction in child mortality, and 63% of the reduction in maternalmortality." Scaling up antiretroviral treatment for HIV/AIDS was judged to be the lowest priority, costing an additional $8.30 per person butmaking "little additional contribution to maternal mortality, while the 6% reduction in child mortality [was] achieved at high unit cost."But with foreign non-governmental organisations managing a larger share of total health expenditure than government, such systematiccost-benefit analyses do not influence national spending priorities. By 2008, the US President’s Emergency Plan For AIDS Relief hadinvested about $200m in HIV/AIDS programmes in Rwanda, including scaling up antiretroviral treatment, which remained one of its mainmeasures of success http://wwwbmj.com/cgi/content/full/341/jul16_1/c3651

TUBERCULOSIS: preventive treatment suggested for AIDS

Treatment as prevention - Evidence is mounting that ARV treatment greatly lowers the likelihood of transmitting HIV, as well as mortality from tuberculosis and other opportunistic infections. Mathematical modelling studies show that implementing voluntary universal testing programmes, and immediately starting ARV treatment for people who test positive, could eventually eliminate HIV all together.

TUBERCULOSIS: South Africa, Aids and TB

SOUTH AFRICA: Mlungisi Dlamini, "We used to have this saying ... 'Any meal might be the last'"JOHANNESBURG, 9 July 2010 (PLUSNEWS) - The future was something Mlungisi Dlamini took for granted; it was not something he planned for until he was diagnosed HIV-positive. He now works with the South African AIDS lobby group, Treatment Action Campaign (TAC), and talked to IRIN/PlusNews about his diagnosis and how it changed his life for the better. "I was diagnosed in 2000 but I usually say I was diagnosed in 2001, because when I was diagnosed in 2000 I didn't receive any counselling. I was just tested because the doctor suspected something and I agreed. "When he delivered the results he just came and said, 'Okay, you are HIV-positive and you don't have to go around just killing other people.' "In 2001 there was a roll-out of voluntary counselling and testing ... that's when I went [for testing] again and received proper counselling. Being diagnosed with HIV - I didn't have a problem with that because I just wanted to know, believe you me, I disclosed the very first day to my family and to my friends. "I started getting sick in 2003-04, when the government started rolling out ARVs. I had pneumonia and I treated that, but it happened I had tuberculosis (TB) but the doctors [at the public clinics] couldn't find it for about five months. "Finally, my former district coordinator at TAC sent me to a private clinic in Soweto, called Lesedi, [where doctors diagnosed my TB] and then I started TB treatment. I told the doctors to wait until I had stopped my TB treatment to start me on ARVs [antiretrovirals]. "ARVs changed my life a lot. I got exposed to the TAC, treatment literacy and virology, and that changed a lot in my mind, it gave me a will to love to help people to understand the virus. "One of the things about growing up in the townships is that I always had bad company ... We didn't care about the future. We used to have this saying - it was from [a movie about the American mafia,] the Gambino family - 'Any meal might be the last'. We used to live by that. We drank, we partied, we drove cars, had women - that was part of life in the township."

TB: money for ARV's

KENYA: For the first time, money for ARVs
NAIROBI, 14 June 2010 (PLUSNEWS) - Kenya has set aside an unprecedented 900 million shillings (US$11.25 million) for the first time in its annual budget to purchase life-prolonging antiretroviral (ARV) medication; AIDS activists have welcomed the move but say more needs to be invested. "It is quite commendable that the government of Kenya has allocated this money, even though we still need much more financial commitment for opportunistic infections like TB [tuberculosis], which is the leading killer for those with HIV," said Everlin Kibuchi, tuberculosis advocacy project manager at the Kenya AIDS NGOs Consortium. "Going from zero to 900 million [shillings] is a huge step in the right direction," said James Kamau, coordinator of the Kenya Treatment Access Movement. Activists have been petitioning the government for many years to boost funding for HIV programmes. Finance Minister Uhuru Kenyatta allocated a further $12.5 million to recruit 15 nurses and five public health technicians in each of the country's 210 parliamentary constituencies, with $62,500 per constituency for the expansion of healthcare. However, the allocation covers just over one percent of the estimated US$959 million gap in funding for treatment and care that Kenya faces over the next three and a half years. Donor funds carry more than 90 percent of HIV programmes, yet the Global Fund to fight AIDS, Tuberculosis and Malaria has rejected Kenya's last two requests for funding and the Clinton Health Access Initiative, which has been providing paediatric ARV formulations, has also withdrawn its support. Despite the drop in funding, the ARV bill is expected to rise significantly after Kenya's decision to adopt the UN World Health Organization's new treatment guidelines, which recommend that patients be given ARVs when their CD4 count - a measure of immune strength - is at 350 rather than at the previously recommended level of 200 before starting treatment. "We just have to wait and see," Everlyn Simaloy, who is living with HIV in the Kibera slum in the capital, Nairobi, told IRIN/PlusNews somewhat sceptically. "We have heard many promises ... if this comes to pass, it implies the government is concerned with the plight of people living with HIV."

TUBERCULOSIS: South African miners at risk

Poor living and working conditions for miners of gold, diamonds and other precious metals have contributed significantly to tuberculosis (TB) epidemics across Africa, scientists said on Tuesday.
Researchers from Britain and the United States said their study suggested that crowded living and working conditions, dust in mines, and the spread of HIV mean Africa's mining industry may figure in up to 760,000 new cases of TB each year.
Men traveling from afar to work in mines, such as from Botswana to South Africa, are at the greatest risk of getting TB, the researchers wrote in a study published in the American Journal of Public Health.
But their wives, children and friends are also at high risk of catching the disease when miners travel back and forth to work, often many times a year.
"Improving living and healthcare conditions for miners may be necessary not only for the miners, but for controlling tuberculosis epidemics throughout sub-Saharan Africa," said Dr David Stuckler from the Department of Sociology at Oxford University, who led the study.
Tuberculosis killed 1.8 million people worldwide in 2008, or nearly 5,000 people a day.
http://www.reuters.com/article/idUSTRE65060120100601

TUBERCULOSIS: Failure to integrate AIDS and Tbc diagnostic centers

DURBAN, 3 June 2010 (PLUSNEWS) - A consortium of AIDS organizations has given the South African government three months to deliver on promises to integrate TB and HIV services. A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF), and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in the port city of Durban. MSF spokesperson Lesley Odendal called the three-month deadline "generous" because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implemention plan. "Patients are still going to different sites, and healthcare workers still have not been trained on new guidelines," said TAC Deputy Secretary General Lihle Dlamini. "One patient who has both diseases should be seen by one healthcare worker with one file." Dlamini noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs. Krista Dong, of the Integration of TB in Education & Care for HIV/AIDS (iTEACH) Programme, based at Edendale Hospital in KwaZulu-Natal Province, said proper training of healthcare workers was crucial. She cited recent research by Health Systems Trust, a non-profit health research organization, which found that nurses' knowledge of potentially dangerous HIV and TB drug interactions continued to be problematic, even with training.

TUBERCULOSIS: Reduction in funding for HIV?AIDS

Titled “No time to quit: HIV/AIDS treatment gap widening in Africa”, the report builds on analyses made in eight sub-Saharan countries to illustrate how major international funding institutions such as PEPFAR, the World Bank, UNITAID, and donors to the Global Fund have decided to cap, reduce or withdraw their spending on HIV treatment and antiretroviral drugs (ARVs) over the past year and a half.
“How can we give up the fight halfway and pretend that the crisis is over? Nine million people worldwide in need of urgent treatment still lack access to this lifesaving care - two thirds of them in sub-Saharan Africa alone. There is a real risk that many of them will die within the next few years if necessary steps are not taken now. Also, the current donor retreat will prevent more people from accessing treatment and will threaten to undermine all the progress made since the introduction of ARVs” says Dr. Mit Philips, Health Policy Analyst for MSF and one of the authors of the report.
The US President’s Emergency Plan for AIDS relief, PEPFAR, reduced its budget for the purchase of ARVs in 2009 and 2010, and also introduced a freeze on its overall HIV/AIDS budget. Other donors, such as UNITAID and the World Bank, have announced reductions over the coming years in the funding for antiretroviral drugs in Malawi, Zimbabwe, Mozambique, Uganda and the Democratic Republic of Congo (DRC).
The Global Fund, the largest funding institution in the fight against HIV/AIDS, faces a major funding shortfall. The US, the Netherlands and Ireland have already announced that they will be providing lower contributions to the Global Fund. In 2009-2010, contributions to already approved country grants were reduced by 8-12%.
http://www.msf.ca/news-media/news/2010/05/hiv-aids-donor-retreat-widens-treatment-gap-in-africa/

GLOBAL FUND: Mauritania fraud

In Mauritania, a full criminal investigation, initiated by the Office of the Mauritanian Inspector General, has led to the arrest of three senior officials in the Executive Secretariat of Mauritania's National AIDS Committee (SENLS), and to the issue of an arrest warrant for a fourth staff member. SENLS is the principal recipient (PR) for Mauritania's Round 5 HIV grant, the only active HIV grant in the country. Meanwhile, investigations have also confirmed systematic fraud by sub-recipients (SRs) in the Global Fund programmes administered by the UNDP, the PR for two malaria grants and two TB grants in Mauritania.

This information is contained in "The Office of the Inspector General Progress Report for October 2009 – February 2010."

TUBERCULOSIS: Inadequacy of screening in AIDS patients

Tuberculosis is a leading cause of death in people with HIV infection, accounting for more than a quarter of the 2 million AIDS deaths in 2008.1 HIV has exacerbated the tuberculosis epidemic globally and especially in Africa—in some sub-Saharan African countries, up to 70% of people with tuberculosis are also HIV positive.2 People with HIV infection also now face the worsening problem of multidrug-resistant and extensively drug-resistant tuberculosis.
Despite remarkable progress in the individual fields of tuberculosis and HIV programming, the gravity and relative neglect of the tuberculosis/HIV crisis deserves further attention. Between 1995 and 2008, the directly observed therapy, short course (DOTS) strategy enabled treatment of 43 million patients with tuberculosis.1 However, until 2004 this strategy did not explicitly include HIV interventions. Furthermore, most HIV services still do not include specific activities for tuberculosis care and prevention. Tuberculosis prevention, screening, and treatment in people with HIV infection remains unsatisfactory. By 2008, only 4% of the 33 million people with HIV infection were screened for tuberculosis, 50 000 received preventive therapy with isoniazid, and just a third of people with both HIV infection and tuberculosis had received treatment for both diseases.1 HIV testing of tuberculosis patients has, however, expanded, to include nearly 1·4 million patients with tuberculosis.1
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60595-8/fulltext

TUBERCULOSIS: Women and children statistics

Globally, 700 000 women die from tuberculosis every year;1 this disease kills more women than do all causes of maternal mortality combined.2 Case-fatality rates seem to be higher in women than in men, and women are more often diagnosed with extrapulmonary tuberculosis.2 This sex difference might indicate under-reporting, because access barriers are higher for women because of sociocultural disempowerment, stigma, different patterns of health-care use, or lack of financial resources; however, poorly elucidated biological factors could account for some of the sex differences.3—6
In tuberculosis-endemic areas, such as sub-Saharan Africa and India, the greatest burden of tuberculosis in women is during the childbearing years (15—49 years); this burden has been greatly exacerbated because of epidemiological changes induced by the global HIV/AIDS epidemic.1, 7 Women account for up to 70% of HIV-infected adults in sub-Saharan Africa, which has shifted the male-to-female case-notification ratio such that more female than male cases of tuberculosis are now detected in countries where the HIV prevalence exceeds 1%.1 Tuberculosis in pregnancy has been associated with increased risk of low birthweight, prematurity, intrauterine growth retardation, and fetal death.8 Maternal tuberculosis is also an important risk factor for tuberculosis and mortality in infants, particularly in babies born to HIV-infected women.9 Targeted strategies to prevent, diagnose, and treat tuberculosis in HIV-infected pregnant women should promote both maternal and child health. Operations research with robust cost-effectiveness analysis is urgently needed to guide the nature and prioritisation of interventions in resource-restricted settings—eg, to assess the value of finding active tuberculosis cases and screening for latent tuberculosis infection, with provision of preventive treatment in HIV-infected women accessing antenatal care.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60579-X/fulltext

TUBERCULOSIS: TB is cause of 25% deaths in AIDS patients

JOHANNESBURG, 19 May 2010 (PLUSNEWS) - Diagnosing HIV early and starting antiretroviral (ARV) treatment could be the most important weapons in the battle against HIV-associated tuberculosis, but this would need a huge injection of resources in southern Africa, where the dual epidemics of TB and HIV claim the most lives. The authors of a paper, part of a series on TB in the British medical journal, The Lancet, note that the disease accounted for more than a quarter of the two million deaths attributed to AIDS-related diseases in 2008, and is the number one cause of illness and death in people living with HIV in Africa, yet efforts to contain TB-HIV co-infection have been "timid, slow and uncoordinated". A move towards earlier HIV testing and treatment is already underway. Many countries have adopted the 2009 World Health Organisation (WHO) guidelines, which raised the threshold for starting ARV treatment from a CD4 count of less than 200, to 350. Earlier ARV treatment as a tool to prevent TB has received less attention, but the reality is that "Many people with HIV infection start ART [antiretroviral therapy] too late, especially in Africa, and have already developed TB by the time that they present to health services for care," the authors said.

POVERTY: Transportation cost affects availability of treatments

BONDO, 17 May 2010 (PLUSNEWS) - Maria Obonyo walked 70km from her home to the nearest hospital in western Kenya's Bondo District to seek treatment for an uncomfortable rash but could not afford the US$2 for the ointment the doctor recommended. "I know I need the drug, but I can't buy it now," Obonyo told IRIN/PlusNews. "The money I have is just enough to buy porridge to give me energy to walk [back home]." When she can afford it, Obonyo, who has been living with HIV for five years, uses public transport to come for her monthly check-up and a refill of her life-prolonging antiretroviral (ARV) prescription; a one-way trip from her home to the hospital costs a little under a dollar. "I will just go back home and wait for them [the rashes] to disappear on their own," she said. The Kenyan government provides free antiretroviral treatment (ART) to more than 300,000 Kenyans and free diagnosis and treatment of TB, which has significantly lightened the financial load of people living with HIV, but for many, the cost of treating opportunistic infections and journeying to and from distant health centres is crippling. About half the Kenyan population gets by on less than $1 a day; in Bondo, with an HIV prevalence of more than 13 percent, an estimated 41 percent live on less than $1 a day.
http://www.itpcglobal.org/images/stories/doc/ITPC_MTT8_FINAL.pdf

AIDS: the money runs out

International support to combat HIV/AIDS is faltering as reflected in significant funding shortfalls. The board of directors of the Global Fund, a key financer of AIDS programmes in poor countries is unable to respond to countries’ needs and will next week in Addis Ababa vote whether or not to suspend all new funding proposals in 2010; and PEPFAR, the US AIDS programme is flatlining funding for two more years. “The Global Fund must not cover up the deficit caused by its funders”, says von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives.” In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programmes.
http://www.msf.org/msfinternational/invoke.cfm?objectid=C34D1CE2-15C5-F00A-25AFA94BDAF99F59&component=toolkit.pressrelease&method=full_html

AIDS: Money running out

The last decade has been what some doctors call a “golden window” for treatment. Drugs that once cost $12,000 a year fell to less than $100, and the world was willing to pay.
In Uganda, where fewer than 10,000 were on drugs a decade ago, nearly 200,000 now are, largely as a result of American generosity. But the golden window is closing.
Uganda is the first country where major clinics routinely turn people away, but it will not be the last. In Kenya next door, grants to keep 200,000 on drugs will expire soon. An American-run program in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots, according to a report by the medical charity Doctors Without Borders.
The collapse was set off by the global recession’s effect on donors, and by a growing sense that more lives would be saved by fighting other, cheaper diseases. Even as the number of people infected by AIDS grows by a million a year, money for treatment has stopped growing.
Other forces made failure almost inevitable.
Science has produced no magic bullet — no cure, no vaccine, no widely accepted female condom. Every proposal for controlling the epidemic with current tools — like circumcising every man in the third world, giving a daily prophylactic pill to everyone contemplating sex or testing billions of people and treating all the estimated 33 million who would test positive — is wildly impractical.
And, most devastating of all, old-fashioned prevention has flopped. Too few people, particularly in Africa, are using the “ABC” approach pioneered here in Uganda: abstain, be faithful, use condoms.
http://www.nytimes.com/2010/05/10/world/africa/10aids.html

TUBERCULOSIS: Zambia prisons

Prisoners in Zambia suffer malnutrition, overcrowding, grossly inadequate medical care, and the risk of rape or torture, the Prisons Care and Counselling Association (PRISCCA), AIDS and Rights Alliance for Southern Africa (ARASA), and Human Rights Watch said in a report released today. Some prisoners are detained for years in such conditions even before they are brought to trial, the groups said.
The 135-page report, "Unjust and Unhealthy: HIV, TB, and Abuse in Zambian Prisons," documents the failure of the Zambian prison authority to provide basic nutrition, sanitation, and housing for prisoners, and of the criminal justice system to ensure speedy trials and appeals, and to make the fullest use of non-custodial alternatives. Poor conditions and minimal medical care for prisoners lead to the transmission of HIV and tuberculosis (TB) – including difficult-to-treat and potentially deadly drug-resistant strains – that threaten the lives of both inmates and the general public, the report says.
“Zambian prisoners are starved, packed into cells unfit for human habitation, and face beatings at the hands of certain guards or fellow inmates,” said Kenneth Roth, executive director of Human Rights Watch. “Children, pregnant women, pre-trial detainees, and convicted criminals are condemned to brutal treatment and are at serious risk of drug-resistant TB and HIV infection.”
http://arasa.info/ZambiaPrisons

TUBERCULOSIS: MDR & XDR, South Africa stats

New forms of highly drug-resistant tuberculosis are emerging and action must be taken soon before they become widespread globally.
Urgent action is needed to implement effective tuberculosis control strategies, especially in countries where tuberculosis control practices have been inadequate.
Research is also needed to assess the extent of the spread of these highly drug resistant strains of tuberculosis worldwide and improved means of diagnosis of tuberculosis and early detection of drug resistance are urgently required, they add.
Among 536 cases of tuberculosis confirmed at a rural hospital in South Africa earlier this year, 41% were multi-drug resistant and of those, 24% met the exact definition of being extensively drug resistant tuberculosis (also referred to as XDR tuberculosis). Such tuberculosis is almost untreatable.
All patients in this outbreak who were tested were HIV positive and 52 of the 53 died after an average of 25 days.
Strains of extensively drug resistant tuberculosis have also been noted in Europe, Asia and North and South America. It appears that there are several strains of this tuberculosis.
http://www.sciencedaily.com/releases/2006/09/060915202534.htm

TB: Nigeria statistics

Nigeria has the highest burden of tuberculosis in Africa. So it is quite correct to say Nigeria has one of the highest risks of contacting tuberculosis, because an individual with tuberculosis, according to the public health scientific information available, can affect 1, 12 to 15 persons per year. Therefore, that there is high risk of getting Tuberculosis when you stay with people with the disease.
Why is it so, is it because we are careless or is there anything we should have done as a country that we have failed to its with regards to preventing the occurrence and spread?
Basically, the reason tuberculosis is a big health problem in our country is because Nigeria is also a country with the highest burden of HIV/AIDS, in sub-saharan Africa, along with South Africa. And because Nigeria has got huge reservoir of people infected with HIV/AIDS, it implies that many immune systems are affected and that predisposes to inciting or activating an existing tuberculosis legion in the land.
http://www.leadershipnigeria.com/columns/views/interview/14227-there-is-high-rate-of-tuberculosis-in-nigeria--dr-kadir