EPCON was thrilled to attend the Union World Conference on Lung Health in early November. The theme for this year’s conference was ‘Combating Pandemics - Today & Tomorrow’. Lung health pandemics, whether COVID-19 or Tuberculosis (TB), continue to cause havoc globally, while exposing inequalities and highlighting the deep interconnectedness of the world.
Getting to zero deaths
Among many other wonderful presentations, Dr Helen Ayles from the clinical research unit, London School of Hygiene and Tropical Medicine shared thought provoking views in her presentation titled ‘Living with HIV but dying from TB: What do we need to do to get to zero deaths?’ A study in the African Journal of Primary Health Care & Family Medicine* looked at post-mortem studies in resource-limited settings, such as the Americas, south Asia and sub-Saharan Africa, and found that TB accounts for approximately 40% of HIV-related adult deaths. Shockingly, half of these TB cases are undiagnosed at the time of death.
Although TB can affect anyone, anywhere, UNAIDS points out that the probability of developing TB is 18 times higher among people living with HIV. TB is also the main cause of death among people living with HIV, accounting for one in three AIDS-related deaths globally. In 2020, an estimated 214 000 people living with HIV died from TB. With numerous informative sessions and interesting panel discussions, EPCON shares the vision of the conference that no one should die of TB in today’s world and we continue to make efforts towards getting to zero deaths.
The WHO guidelines outline the package of care for those living with advanced HIV disease.
Package of care
For those with advanced HIV, the package of care should include the following:
All people living with HIV should be tested for TB, and all people with TB should be screened for HIV. Resource-constrained settings still suffer from insufficient diagnostic capacities and methods requiring sputum for TB testing among PLHIV can be inefficient.
Improving the coverage of Antiretroviral (ART) treatment is essential to reduce the mortality burden associated with HIV. Despite this, one in three people still present to health facilities with advanced HIV disease. Sadly, this proportion is higher in low and middle-income countries or where there are treatment interruptions.
Advanced HIV disease exposes people to a high risk of disease from serious opportunistic infections, such as cryptococcal meningitis, or severe bacterial infections, even after starting ART. More than 1 in 10 HIV-related deaths are as a result of cryptococcal meningitis.
Screening, treatment and / or prophylaxis for major opportunistic infections is crucial. TB can be treated prophylactically and be repeated at regular intervals.
The importance of continuous social and emotional support to ensure treatment regime adherence should not be underestimated..
In essence, TB and HIV services need to be integrated to reduce mortality substantially. EPCON can play a key role in achieving this objective with its MATCH AI predictive infectious disease modelling capacities and AI driven smart M&E tools.
* Mntonintshi, M., O’Mahony, D., Mabunda, S., Namugenyi, K. 2017. Undiagnosed tuberculosis in patients with HIV infection who present with severe anaemia at district hospital. African Journal of Primary Health Care & Family Medicine. 9(1): 1406.