Zimbabwe has the dubious distinction of having an estimated 15% of all 15- to 49-year-olds to be living with HIV and 74% of the 38,720 tuberculosis patients co-infected with HIV. A TB-HIV integrated care project managed by The Zimbabwe Office of the International Union Against Tuberculosis and Lung Disease (The Union) has shown in its second-year results, significantly improved care for people requiring simultaneous treatment for both diseases. The Union project, which was launched in October 2011, is being implemented in 23 clinics in 17 urban areas in Zimbabwe with funding from the US President’s Emergency Fund for AIDS Relief (PEPFAR). The aim is to strengthen both TB and HIV diagnostic and treatment through decentralisation and integration of TB-HIV services in urban primary health care clinics.
At the time the project began in 2011, 90% of all the TB patients in Zimbabwe were being tested for HIV and over 90% of those who tested to be HIV positive were started on cotrimoxazole preventive therapy (CPT). However, only 60% had access to antiretroviral treatment (ART), and people living with HIV (PLHIV) were not routinely screened for TB in HIV care settings due to centralised HIV care services and inadequate implementation of TB and HIV collaborative activities. Since the start of the project, treatment of sputum smear-positive TB cases has been decentralised to all 1,643 public health facilities; but only some 300 facilities currently offer ART.
The 23 clinics participating in The Union project offer a full range of collaborative TB-HIV activities, as recommended by The World Health Organization. For example, these integrated services include not only CPT and ART initiation and follow-up, but also TB screening, diagnosis and treatment. In addition, the clinics provide intensified TB case finding for patients in HIV care or on ART; provider-initiated counselling and testing (PITC) for HIV for family members; and TB infection control measures protecting all patients and staff.
Following are the results achieved by the 23 clinics from October 2012 to September 2013 as compared to the national averages: HIV testing for TB patients: 91% of the TB patients (2,812 out of 3,096) were tested for HIV against the national average of 90% in 2011
CPT for TB patients living with HIV: 89% of the HIV-positive TB patients (1,833 out of 2,069) received CPT against the national average of 94%. ART for TB patients living with HIV: 1,390 (67%) HIV-positive TB patients out of 2,069 received ART as compared to the national average of 60%
TB screening for PLHIV: 37,141 HIV-positive patients were seen in HIV care settings. As standard HIV care practice, all such patients were routinely screened for TB. 1,628 (4.3%) were confirmed TB positive and commenced TB treatment. Infection control –All the 23 clinics conducted 6-monthly TB symptom screening among their health workers. This activity has not yet been adopted as national policy and therefore is not promoted or recorded nationally.
“The progress showed by the Zimbabwe project demonstrates that effective TB-HIV integrated care can be implemented under the difficult and challenging conditions that are often found in low- and middle-income countries”, says Jose Luis Castro, Interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union). “With the recently renewed PEPFAR funding, we hope that this progress will be replicated widely in the coming years”.
Citizen News Service - CNS
November 2013