It is a well known fact that Dec. 1 is World AIDS Day. Less well known is that tuberculosis (TB) is the largest killer of those living with HIV/AIDS.
Michel Sidibe, Head of UNAIDS, said recently, “Halving TB deaths in people living with HIV by 2015 is possible and is within our reach. We could save up to a million lives by 2015 and bring us one step closer to the UNAIDS vision of ‘Zero AIDS deaths.’”
Testing people for TB is critical to addressing both the global TB and HIV crises. We cannot hope to address these pandemics if we don’t first identify those who have TB and are in need of treatment. For scientists and advocates, this means increasing case detection efforts in key-affected communities with a high burden of disease.
People living with HIV are a key-affected community. HIV positive people have an estimated 20-30 times greater risk of developing active TB, which is the leading cause of death for people living with HIV/AIDS and is responsible for 1 in 4 of these deaths globally.
However, according to a report published in October, only 7 percent of people living with HIV are being tested for TB. Granted, an improvement from 2008 when only 1 percent of people living with HIV were being tested for TB. But, given that 25 percent of people living with HIV/AIDS will die from TB, we are only reaching the tip of the iceberg.
On World TB Day 2009, the Canadian government announced a major contribution, almost 100 million dollars over 5 years, for a new facility at the World Health Organization that would receive applications and give out small grants to increase TB case detection. This announcement came after months of campaigning by RESULTS Canada volunteers and staff.
The main objective of this new facility, TB REACH, is “to promote early and increased case detection of TB cases and ensure their timely treatment, while maintaining high cure rates within the national TB programs.” And they are using some unique ways to accomplish this.
In a remote, mountainous region of Lesotho, a TB REACH grant sent people in on horseback on a regular basis to collect samples, bring them back for testing and ensure that those that tested positive for TB were able to access treatment via return text messages to community health workers. To date, almost 50 million dollars has been given out as grants from TB REACH. Other than some important administrative support from the UK, all of the grant money is from Canada.
In the rural area of Mbewa in Tanzania, a TB REACH grant has helped bring state-of-the-art technology to communities to identify TB cases. A mobile van which provides HIV testing now also has the most up to date TB test—the Xpert test can provide a result in 90 minutes!
Now, instead of having to wait days or weeks and make multiple trips to get tested, diagnosed and start treatment, the Xpert test means all this can be accomplished the same day, and can mean the difference between life and death for many as countless people with TB die while waiting for test results.
TB case detection has doubled in Mbewa since the TB REACH grant made the Xpert test available with the mobile van.
“This is the first time that this new diagnostic tool (Xpert) has been used at a community level at rural health centers and on a mobile van.” said Dr. Petra Clowes of the TB REACH initiative. “It is quite exciting to see the immediate benefits of such amazing technology among populations that previously had such poor access to healthcare.”
The recent World AIDS Day on Dec. 1 can mark a moment when significant traction was gained. The AIDS community has set itself a bold new goal of “Zero Deaths” to build upon previous goals of increasing access to safe and affordable treatments for all.
Paramount to achieving the goal of zero deaths from HIV/AIDS, universal detection and treatment of TB is needed in people living with this virus. The WHO’s Save a Million Lives Campaign is a step in the right direction—it is a plan to reduce TB deaths in people living with HIV by a million between now and 2015.
As TB is the leading cause of death for people living with HIV/AIDS and accounts for one-quarter of all HIV/AIDS related deaths, scaling-up our ability to find and treat TB cases among these patients is critical.
Canada has been a leader in TB case detection by launching and providing the first years of funding to TB REACH. Unfortunately, there is no dedicated stream of funding for detecting TB cases in people living with HIV/AIDS. To ramp up resources needed to Save a Million Lives, Canada should use its leadership as the first and only major funder of TB REACH to push the establishment of a dedicated stream for detecting TB in people with HIV/AIDS.
With stable, secure funding that targets TB and HIV specifically, TB REACH could do much more to reduce deaths among co-infected people, be a leader in the drive to Save a Million Lives, and attract more donors to increase the number of life-saving grants in the coming years.Treating HIV/AIDS without concomitant detection and treatment of TB is unethical and ineffective use of our precious overseas assistance dollars. Encouraging CIDA and our parliamentarians to follow this path will most certainly shine Canada’s light brighter on the world stage.
Dr. Bob Dickson is a partner with RESULTS Canada, a non-profit organization dedicated to ending abject poverty and debilitating diseases in our world. Katy Kydd Wright is the Director of Campaigns with RESULTS Canada. www.results-resultats.ca