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Vienna 2010:TB screening - more talk, no action

http://healthdev.net

Health advocates are outraged by MOSOTOS (More Of the Same Talk Opinions and Speeches) with little implementation of the same.

This week the world is converging in Vienna Austria for the 18th International AIDS conference. More pledges, promises and declarations will be made to add to others that have been made previously without any or very minimal implementation if any.

One failed promise is that of TB screening among people Living with HIV. (PLWHAs). To date globally, only 4.1% of PLWHAs are screened for TB despite the infection being the leading killer of PLWHAs. It is worse in Africa which is at 3%. Almost 25% of PLWHAs eventually die from TB because they are not tested for it and therefore not properly treated.

According to WHO 2009 Global Tuberculosis Control report, a total of 1.4 million HIV positive people attending HIV care services were screened for TB. This is only 4.1% of the total 33.3 million estimated PLHAs.

For two decades, the HIV/AIDS community has known that TB and HIV/AIDS are intimately linked, particularly in sub Saharan Africa where HIV has caused TB incidences to triple since 1990. Yet after so many promises, declarations and calls to action HIV programs are still failing to identify the most likely infection to kill those accessing HIV services.

‘I have had HIV for almost 20 years and the only time I ever came close to dying was with TB.’ Said Lucy Chesire a renowned TB HIV advocate from Kenya. It took seven months in a hospital bed before the doctors could think of screening me for TB. I am not sick from TB anymore but I am sick, tired and fed up that screening is not being provided to 96% of HIV positive people.

Unlike Lucy who was lucky to survive, many patients today are dying of TB without ever knowing they suffered from TB. ‘WHO recommends every person with HIV/AIDS to be screened of TB’. Said Emily Wright, Project Director for Advocacy to Control TB Internationally (Action). ‘So the fact that only 4.1% of HIV positive people around the world are screened for TB is simply rampant unmitigated malpractice’. Concluded Emily a TB advocate.

Country level programs are not the only actors that are failing on this issue. The leading sources of International HIV/AIDs funding the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS TB and Malaria (GFATM) and the World Bank do not routinely monitor the number of PLHAs being screened for TB in HIV/AIDS programs they support.

‘None of the three biggest AIDS donors are reporting the proportion of PLHAs being screened for TB’. Said Wainwright. It is essential that these donors ramp up HIV testing to TB patients further operationalize stated commitments to collaborative TB HIV services and significantly increase resources to address the same.

To stop PLHAs dying of TB, programs must screen all PLHAs accessing care for TB and make the�three Is ( Intensified Case Finding, Infection Control, and Isoniazid Preventive Therapy ) central to HIV/AIDS services and universally available.

Affected countries donors and technical agencies must act to ensure universal access to quality TB- HIV care by year 2015- moving in coordination with the goal of Universal access to ART. Likewise heads of state and ministers of health endemic countries must take the lead in committing to a goal of universal access by 2015 on TB –HIV care.

‘The time for MOSOTOS is over. It is time to take action!’ Concluded Lucy Chesire also calling for integration of TB and HIV services. ‘TB and HIV services should be accessed from one point, from one nurse, from one facility on one day. Stop dividing the patient and wasting their time seeking services instead of being economic productive in their own ways ’ said Lucy.