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Supporting an integrated approach to HIV and tuberculosis care

Health services in Benin and the Democratic Republic of Congo (DRC) have introduced an integrated approach to HIV and Tuberculosis care which is helping to decrease mortality and improve the quality of life of HIV/TB patients.

The International Union against Tuberculosis and Lung Disease has been collaborating with the national health services of Benin and the Democratic Republic of Congo within the context of its ‘Integrated HIV Care for Tuberculosis Patients Living with HIV/AIDS’ (IHC) programme.

The IHC programme provides TB patients who are registered for TB treatment under national programmes, as well as their relatives, with rapid HIV testing, treatment and counselling. Its aim is to increase the capacity of national health services to provide integrated care and support to HIV/TB patients. The programme is supported (90% funding) by the European Union.

It is estimated that up to 70% of TB patients in sub-Saharan Africa are co-infected with HIV (WHO Report 2005). Indeed, HIV-positive people are up to fifty times more likely to develop tuberculosis (TB) in a given year than those who are HIV-negative. Access to standardised HIV care is, however, limited in many low-income countries. It is believed that integrating the approach to these two large-scale problems may help reduced their burden on society and better integrate the care of HIV patients into the general health services.

Achievements

The implementation of the IHC programme in Benin was carried out in close collaboration with the Ministry of Health (MOH), the National Tuberculosis Programme (NTP) and the National AIDS Programme (NAP). An IHC office was established in Benin’s capital, Cotonou, to oversee and coordinate activities. The programme was implemented in 20 TB diagnostic and treatment centres (DTCs) in all regions of the country with the following results:

  • All DTCs offered HIV testing to their TB patients, and provided cotrimoxazole prophylaxis - a lifesaving, simple and inexpensive intervention.;
  • The NAP accredited several DTCs as antiretroviral (ARV) prescribing sites;
  • DTCs located near an existing NAP site referred patients eligible for antiretroviral treatment (ART) to that site;
  • Stocks of rapid HIV tests and antiretroviral medications purchased by the project were handed over to the NAP, which distributed them to the DTCs and committed to continue supplying them after the project ended in November 2008;
  • DTCs not located near a NAP laboratory were provided with equipment and material for performing manual HIV tests based on CD4 cell counts;
  • Over 100 health care workers (doctors, nurses, laboratory technicians) received specific HIV training.
  • TB patients diagnosed with HIV were placed on cotrimoxazole prophylaxis and, when eligible, started on antiretroviral therapy shortly after the diagnosis of their TB. More than 3 500 TB patients benefitted from HIV diagnosis and care from 2005-2008;
  • The success of IHC activities in the 20 pilot sites has encouraged the NTP to expand TB-HIV activities nationwide. All DTCs in Benin now routinely offer HIV testing to TB patients.

In the DRC, the IHC programme was implemented in collaboration with the National Tuberculosis Programme (NTP) and the National AIDS Programme (NAP). The first phase of the IHC programme was implemented in 23 TB diagnostic and treatment centres (DTCs) in two provinces: North Kivu and Bas Congo. Activities in North Kivu continue within the framework of the second phase of the IHC programme, also funded by the European Commission.

The IHC programme introduced HIV screening and management of co-infected TB patients by health care staff in charge of TB services. Co-infected patients were started on cotrimoxazole preventive therapy (CPT) and if eligible, also on antiretroviral treatment (ART). CD4 cell count measurement was also introduced at all sites. Results include:

  • TB patients benefitted from increased access to HIV diagnosis and care;
  • Diagnostic and treatment centres (DTCs) for TB care were equipped with a 3-year supply of rapid HIV tests and anti-retrovirals drugs;
  • Health care workers were trained in HIV counselling, diagnosis and integrated HIV care for TB patients;
  • Diagnostic counselling and testing for HIV was made more widely available.