HIV and tuberculosis (TB) are a deadly combination. TB is the leading cause of death among individuals living with HIV, accounting for 25% of HIV-related deaths among HIV positive people.
TB is an opportunistic infection that more easily takes hold in individuals with weakened immune systems. An individual living with HIV is 20 to 30 times more likely to develop TB than an uninfected person.
MHRP implements PEPFAR-funded HIV prevention, care and treatment programs at multiple sites in Sub-Saharan Africa, a region that bears the highest burden of co-infection worldwide, accounting for 82% of HIV-positive incident TB cases in 2010.
Dr. Elizabeth Harausz is an MHRP research physician specializing in multi-drug resistant tuberculosis. She cites difficulties in diagnosing TB and integrating HIV/TB care and treatment efforts as obstacles to reducing TB cases in areas where MHRP works.
“In Sub-Saharan Africa 36% of TB patients have HIV, but frequently HIV and TB clinics are not well integrated. One problem is that, often, TB clinics aren’t testing for HIV, and HIV clinics aren’t testing for TB,” said Dr. Harausz. “In HIV positive people, TB goes undiagnosed until death half of the time.”
Dr. Harausz is developing some research to inform solutions to this problem. One study plans to look at the use of GeneXpert TB tests in ambulatory HIV clinics to return diagnoses more quickly and connect those with co-infection to the appropriate care and follow-up.
PEPFAR has released new indicators looking specifically at TB/HIV co-infection with the goal of focusing more attention on the diagnosis and treatment of co-infected individuals and following the TB care cascade. “These new indicators should allow for a better understanding of the TB/HIV epidemics at our sites, and therefore help us improve the care we provide to our patients,” said Dr. Harausz.