How Human Immunodeficiency Virus Voluntary Testing Can Contribute to Tuberculosis Control. (Policy and Practice)

Article excerpt

Abstract Human immunodeficiency virus (HIV) is fuelling the tuberculosis (TB) epidemic, particularly in sub-Saharan Africa. However, despite their close epidemiological links, the public health responses have largely been separate. WHO has set out a strategy to decrease the burden of HIV-related TB, comprising interventions against both TB and HIV. Voluntary counselling and testing (VCT) for HIV can link TB and HIV programme activities. The benefits of VCT for HIV to TB patients include referral for appropriate clinical care and support for those testing HIV-positive. Likewise, people attending a centre for VCT can benefit from TB screening: those found to be both HIV-positive and with active TB need referral for TB treatment; those without active TB should be offered TB preventive treatment with isoniazid.

To explore how VCT for HIV can contribute to a more coherent response to TB, WHO is coordinating the ProTEST Initiative. The name "ProTEST" is derived from the Promotion of voluntary testing as an entry point for access to the core interventions of intensified TB case-finding and isoniazid preventive treatment. Other interventions may be added to provide finally a comprehensive range of HIV and TB prevention and care interventions. Under the ProTEST Initiative, pilot districts are establishing links between centres for VCT for HIV and TB prevention and care. This will pave the way for large-scale operationalization of the comprehensive range of interventions needed to control TB in settings with high HIV prevalence.

Keywords Tuberculosis, Pulmonary/prevention and control/epidemiology/diagnosis; AIDS serodiagnosis; Counseling; Volition; AIDS-related opportunistic infections/prevention and control; HIV seroprevalence; Delivery of health care, Integrated; Cost of illness; Pilot projects; Africa South of the Sahara (source: MeSH, NLM).

Mots cles Tuberculose pulmonaire/prevention et controle/epidemiologie/diagnostic; Serologie HIV; Conseil; Volition; Infections opportunistes liees SIDA/prevention et controle; HIV seroprevalence; Distribution integree soins; Cout maladie; Projet pilote; Afrique subsaharienne (source: MeSH, INSERM).

Palabras clave Tuberculosis pulmonar/prevencion y control/epidemiologia/diagnostico; Serodiagnostico del SIDA; Consejo; Volicion; Infecciones oportunistas relacionadas con el SIDA/prevencion y control; Seroprevalencia de VIH; Entrega integrada de atencion de salud; Costo de la enfermedad; Proyectos piloto; Africa del Sur del Sahara (fuente: DeCS, BIREME).

Bulletin of the World Health Organization 2002;80:939-945.

Introduction

The human immunodeficiency virus (HIV) pandemic is the world's leading public health emergency, with a particularly severe impact on sub-Saharan Africa. It is destroying the health of Africans, the economies of African nations and their prospects for development. HIV infection is also fuelling the tuberculosis (TB) epidemic, but TB programmes have focused on TB case-finding and treatment, with little attention to HIV/ AIDS interventions. Although TB is a leading cause of HIV-related morbidity and mortality, HIV/AIDS programmes have generally paid little attention to TB. Thus, despite close epidemiological links between HIV and TB, the public health responses have largely been separate.

WHO has developed an expanded strategy to decrease the burden of HIV-related TB, requiring close collaboration between TB and HIV programmes (1). The strategy comprises interventions against TB, including intensified case-finding, cure and preventive treatment, as well as interventions against HIV (and therefore indirectly against TB). The latter include counselling for decreased sexual risk behaviour, provision of condoms, treatment of sexually transmitted infections, promotion of safety for intravenous drug users and provision of highly active antiretroviral treatment. WHO and collaborating bodies have embarked on "The ProTEST Initiative" as a starting point at district level for this comprehensive range of interventions aimed at decreasing the burden of HIV-related TB. …