Abstract
The dramatic spread of the HIV epidemic throughout sub-Saharan Africa in the past decades has been accompanied by up to a fourfold increase in the number of tuberculosis cases. This suggests that TB control will not make much headaway in HIV prevalent settings until HIV control is also achieved. To curb this growing pandemic of TB/HIV coinfection, WHO has drawn up guidelines to expand collaboration between national tuberculosis and HIV/AIDS programmes, with a principal focus on Africa where 70 % of the world's 14 million people who are coinfected live.
The basis of this student thesis are WHOs guidelines for collaborative activities. We outline how low-income countries can implement coordiated TB/HIV activities in the home/community and primary level of the health care system, in the light of the excisting situation in these countries. We also analyse how the two programmes may develop areas of potential synergy, such as models of care delivery, monitoring of adherence of treatment and community mobilization.
To control tuberculosis in high HIV prevalence populations there are urgent needs of interventions against tuberculosis (intensified case- finding and cure and tuberculosis preventive treatment for HIV- infected) and interventions against HIV (and therefore indirectly against tuberculosis), e.g. education, condoms and highly active antiretroviral treatment.
There are many unexploited potential synergies between TB and HIV/AIDS programme objectives and activities. Collaborative TB/HIV interventions are necessary to control the HIV-induced tuberculosis epidemic. There are however a lot of challenges. There are several controversies in the diagnostic and treatment for tuberculosis in HIV- infected, and the need for more research is evident. The main problem still remains – how to raise the additional resources needed.