Role of the US President's Emergency Plan for AIDS Relief in Responding to Tuberculosis and HIV Coinfection
ABSTRACT The intersection of tuberculosis (TB) and human immunodeficiency virus (HIV) infection has eroded gains made in TB control, because previously well-functioning national TB programs have been overwhelmed by the dual challenges posed by TB and HIV coinfection. The US President's Emergency Plan for AIDS Relief (PEPFAR), through its direct support of >2.4 million persons receiving HIV treatment and, in 2009, support of >308,000 HIV-infected persons receiving TB treatment, works closely with national governments and other partners to strengthen the response to TB and HIV coinfection. PEPFAR-supported activities fall within the World Health Organization's 2004 framework for collaborative TB and HIV activities, including critical interventions to (1) develop organizational methods of collaboration across the 2 programs, (2) reduce the burden of HIV infection among patients with TB, and (3) reduce the burden of TB among persons with HIV infection or AIDS. To date, PEPFAR and partners have made important gains in coverage and scope of HIV testing, referral, and antiretroviral therapy for patients with TB. TB screening of HIV-infected patients is also beginning to increase, although greater progress needs to be made in increasing access to isoniazid preventive therapy and strengthening TB infection control. Continued strategic integration of TB and HIV interventions into PEPFAR-supported programs is essential to easing the patient burden of dual infection, improving patient outcomes, and, ultimately, decreasing rates of TB in areas with a high prevalence of TB.
SourceAvailable from: Henry Mbah
Dataset: Intergration paper
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ABSTRACT: The surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration.PLoS ONE 09/2014; 9(9):e107277. DOI:10.1371/journal.pone.0107277 · 3.53 Impact Factor
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ABSTRACT: Background. There is limited data measuring the impact of expanded HIV prevention activities on the tuberculosis (TB) epidemic at the country level. Here, we characterized the potential impact of PEPFAR on the TB epidemic in sub-Saharan Africa.Methods. We selected 12 focus countries (countries receiving the greatest US government investments) and 29 non-focus (or 'control') countries. We used TB incidence and mortality rates and relative risks to compare time periods before and after PEPFAR's inception, and a TB/HIV indicator to calculate the rate of change in TB incidence relative to the HIV prevalence.Results. Comparing the periods before and after PEPFAR's implementation, both TB incidence and mortality rates have diminished significantly and to a higher degree in focus countries. The relative risk for developing TB, comparing those with and without HIV, was 22.5 for control and 20.0 for focus countries. In most focus countries, the TB epidemic is slowing down despite some regions still experiencing an increase in HIV prevalence.Conclusions. This ecological study showed that PEPFAR had a more consistent and substantial effect on HIV and TB in focus countries, highlighting the likely link between high levels of HIV investment and broader effects on related diseases like TB.The Journal of Infectious Diseases 08/2013; DOI:10.1093/infdis/jit406 · 5.85 Impact Factor