Lung diseases, and especially pneumonia, are major causes of morbidity and mortality among children infected with HIV in low-income countries. In TB-endemic countries, tuberculosis is common in HIV-infected children, although it frequently presents with the symptoms of acute severe pneumonia. Other HIV-related lung diseases, such as Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV), have been seen increasingly in children. With improved survival, due to increased ART uptake, the number of children with chronic lung diseases, such as lymphocytic intersitial pneumonitis (LIP) and bronchiectasis, is also increasing.
To address this issue, The Union's Child Lung Health Division organised the 1st International Course on the Management of Childhood Lung Disease in the HIV-Positive Child. The eight-day course was held at the Korea Garden Lodge, Lilongwe, Malawi, 1–10 August 2011 and funded by the Norwegian Agency for Development Cooperation (Norad).
As TB is a major co-infection, managers of the national TB programmes (NTPs) and national AIDS programmes (NAPs) in sub-Saharan countries were each asked to nominate someone to attend the course (ideally, a paediatrician) who was with their respective programmes and who was or could become the focal person for childhood TB/HIV within their programmes. The aim of bringing together people from the different programmes was to facilitate collaboration between the NTPs and NAPs and support the integration of services. There were 18 participants nominated from 9 sub-Saharan countries – Kenya, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe – and they represented various health care backgrounds and disciplines, but the majority were paediatricians or paediatric residents.
The first four days of the course focused on the clinical aspects of childhood lung disease in the HIV-infected child. The group also discussed the situational analyses prepared by each country in advance and identified areas requiring research. These activities laid the groundwork for the second half of the course, which focused on the programmes and activities needed to strengthen health service delivery, including data management and operational research.
By the end of the course, each country's participants had developed and presented a draft operational research proposal to address an identified problem specific to their working environment. As follow-up, each team was assigned one of the course's facilitators to provide support and advice on request and to assist them in taking their research forward.
The course offered the opportunity for health professionals within the region to meet and exchange ideas and experiences and to discuss ways of developing a more integrated approach for the management of childhood TB and HIV within national programmes.