When the human immune system is lowered by HIV infection, TB bacteria act as an opportunistic organism, capitalizing on a weakened body. According to the World Health Organization, a person with HIV is 26 to 31 times more likely to develop TB.1 This coinfection causes symptoms associated both with TB, such as muscle loss and severe coughing, and HIV, such as fever, fatigue, and diarrhea. In 2014, 400,000 people died from a coinfection of TB and HIV. 2
Many health programs have begun to integrate services for HIV and TB as a means to treat patients with coinfections. CHMI profiles twenty-five programs that are integrating these services. Tegemeza in Kenya, for example, provides dual HIV/TB services for coinfected patients in one visit. This “one-stop-shop” method helps to cut administrative and consumer costs, and reduces the amount of times a person needs to visit the clinic. Other approaches to integrating services include scaling up home-based care, building capacity with mobile technologies, and integrating services through policy initiatives.
Scaling-Up Home Care
Home-Based Care (HBC) has been a component in treating millions of people living with HIV and TB in sub-Saharan African countries. However, this type of treatment has suffered many setbacks, including strained community partnerships, lack of training, and stigmatization, which can reduce the effectiveness of HBC.3
Health at Home/Kenya is working to scale-up HBC in Kenya through training providers, using GPS-enabled tracking systems to monitor patients, and testing for both HIV and TB at home visits. This organization fights stigmatization by using trained counselors and nurses, who offer confidential, one-on-one care to every person tested. A 2012 impact evaluation of this program indicated that 97 percent of the targeted population accepted HIV counselors into their home, and 3,000 people have been directly connected with treatment since the program’s inception.4 Tateni Home Care Nursing Services and Bambisanani Project are also working to scale-up HBC so as to treat TB/HIV coinfections. Both programs aim to change behaviors surrounding TB/HIV care through establishing a strict adherence to medication regiments and training family members and nurses to care for the patient.
Capacity Building with Mobile and Electronic Technology
Six programs in CHMI, such as the Dokoza System for Disease Management in South Africa, are specifically using mobile methods to improve data tracking for patients with HIV/TB coinfections. Dokoza provides real-time data, such as diagnoses and health statuses, for doctors, nurses, and health workers for a more consolidated and organized system that takes initiatives in recording the history of patients with TB/HIV coinfections. Health providers utilize SIM cards that can be used across health networks in mobile phones to access records, and then integrates these records with existing hospital information systems.
Health Care at My Fingertips (HCAMF) equips rural community health workers in Kenya with eHealth Tablets, a technology that can be used for patient data collection, patient record keeping, and patient-provider teleconsultations. Through these teleconsultations, connections between rural patients with HIV/TB coinfections, including pregnant women and orphaned children, are paired with diagnostic and treatment options at a low or free cost. Similar programs using information and communication technology include Reach Out Mbuya Parish HIV/AIDS Initiative and Open Medical Record System (OpenMRS).
Policy, Advocacy, and Monitoring Initiatives to Strengthen TB and HIV Services
Strengthening TB and AIDS Response-East Africa (STAR-E) aims to create change through monitoring and advocacy activities to strengthen health networks. A USAID initiative, this organization strives to increase demand for TB/HIV services through the dissemination and application of evaluation results of community-based TB/HIV organizations. STAR-E also provides communication linkages between organizations throughout East African countries. A process evaluation of STAR-E shows that 93% of patients with TB were tested for HIV.5
3Is Continuum Care Cambodia, a policy-based government program launched in 2010, aims to dramatically scale-up the number of TB screenings, especially among those with confirmed cases of HIV. The program follows a three-step approach, including intensified TB case finding among people living with HIV (PLHIV) and their household contacts (1), isoniazid Preventive Therapy for PLHIV unlikely to have active TB (2), and improved TB infection control: Measures at Continuum of Care and Home-Based Care (HBC) settings (3). Through this program, the number of adults and children on Anti-Retroviral Therapy (ART), in addition to the number of clinics providing ART services, has steadily increased.6
Looking to the Future
CHMI will continue to work with and profile organizations in Low-to-Middle Income Countries that carry out necessary services and seek to learn about innovative approaches to preventing, monitoring, and treating people with this coinfection.
Photo c/o Health at Home/Kenya