Tuberculosis and HIV are responsible for the greatest burden on public health systems around the world. Their individual burdens continue to rise, straining the abilities of public health through their subsequent morbidity and mortality, yet their disease patterns are also linked to each other. TB, for example, is one of the leading causes of mortality in people living with HIV/AIDS (Getahun 2004). Globally there are an estimated 12 million people co-infected with TB and HIV, and two thirds of AIDS patients in Sub-Saharan Africa suffer from TB as well (TB Alliance 2005). By accelerating HIV disease progression, the interaction of TB and HIV makes TB mortality four times higher among HIV patients and non-HIV patients, while also increasing the overall TB infection and transmission rate (Coatzee 2004). Co-infection between TB and HIV catalyzes their effect on both the population's health and the population's resources. Yet although their joint burden can be understood, it is often not even recognized within the population. In South Africa it is estimated that 10% of HIV-positive persons know their status, which only increases the risk of both HIV and TB transmission (Karim 2004).
[...] Finally, one of the major complications in joint TB/HIV control is maintaining the momentum of HIV HAART drugs once the TB therapy is completed. Traditional TB therapy is relatively short, yet HIV therapy lasts a lifetime, and this could be challenging if a program's inherent foundation is the coordination of both therapies. The collaboration of TB and HIV programming and therapy could dramatically aid in reducing the co- infection burden, yet this effort must be carefully planned to fit within the constructs of a given country's public health infrastructure. Works Cited Coatzee, David, et. al. [...]
[...] USAID has since began working with PNLT to enhance the coordination between HIV and TB programs, with the coordination of case detections being their primary concern. The public health infrastructure in Haiti is heavily reliant on community health systems, especially rural clinics, and the power of social diffusion of information. In their efforts to combat TB/HIV co-infection, Haiti has been using their unique infrastructure as a strength, training clinic workers to identify and counsel TB patients once tested for HIV, and placing preventive TB care (such as isonazid therapy) in the homecare setting that HIV usually takes place in. [...]
[...] TB programs may already be stretched for resources, funding, and maintaining patient adherence, so adding the complex burden of HIV control could possibly decrease the quality of care received for both. Ideally, coordination for TB/HIV prevention and care should not negatively affect the current status of TB care (especially if HIV care is being added to an existing TB program), yet with resource limitations, countries must decide which route will serve the health needs of their population better- TB/HIV or just TB efforts. [...]
[...] The structure and accountability of the DOTS approach can translate into approaches to HIV care through highly active anti-retroviral therapy (HAART), so that the principles that lead to regimen adherence in TB care will improve the quality of HAART delivery and follow-through. Especially with the development of HAART, it is important for countries to develop sustainable strategies for delivery of HIV care, and the linkage to existing TB programs would significantly assist this (Karim 2004). The World Health Organization (WHO) is a strong advocate for the coordination of TB and HIV activities. In general, they recommend joint surveillance, planning, monitoring and evaluation of TB/HIV co-infection in order to decrease the burden of TB in HIV patients and HIV in TB patients. [...]
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