Participants in a TB-HIV workshop in Mozambique were advised by the World Health Organization (WHO) that more lives can be saved by improving implementation in decentralised and integrated settings than by centralised and specialised HIV care and antiretroviral therapy (ART) services.
Teams from 14 sub-Saharan countries met with officials from WHO, the United States Agency for International Development (USAID) and regional organisations representing people living with HIV (PLH) for the three-day workshop on TB-HIV collaboration, held in Maputo on April 10–12. The event was designed to give participants the opportunity to review progress and discuss next steps for expanding implementation. A team from The Union Zimbabwe Office represented The Union.
Dr Diane Havlir, chairperson of WHO's TB-HIV Working Group, told participants that all the tools for improving joint TB and HIV services are now available. More lives can be saved, she said, through task-shifting, task sharing and other improvements in the implementation of services in decentralised settings, rather than by offering more centralised and specialised HIV care and ART services.
The teams discussed key issues, such as how to achieve universal access to antiretroviral treatment (ART) for TB patients; develop new models of care that can support the scale-up of TB-HIV services; draw up infection control guidelines and put them into practice; conduct intensified case finding in health facilities and community settings; remove the barriers to the implementation of isoniazid preventive therapy; monitor and evaluate TB-HIV activities; and capture data to improve services.
Dr Havlir urged participants to think in new ways about how to prevent HIV infections, prevent TB in PLH, diagnose TB and drug-resistant TB and ensure the rapid start of ART in PLH with TB. She also stressed the need to plan services so that patients are not lost in the 'transitions': for example, from the TB clinic to the HIV testing point or from TB care to HIV care and ART.
In conclusion, she made a passionate call for WHO and the national programmes to consider improving data collection to measure TB treatment outcomes in both PLHs and HIV-negative TB patients, the time it takes to start ART from the start of TB treatment in PLHs who also have TB, the number of PLH who had TB who are retained in care at 12 months after starting ART, the number of PLH who have a viral load measurement at 12 months and the number of PLH who have a suppressed viral load.