TB-HIV Collaboration in India
India is extremely vulnerable to tuberculosis (TB), as out of the 2.1 million people living with HIV, 110,000 are co-infected with TB (Global Tuberculosis Report 2015, WHO). Spread by something as simple as a cough, TB can affect any individual or a family, especially a family living with HIV.
TB-HIV collaborative activities were initiated by Revised National Tuberculosis Control Programme (RNTCP) and National AIDS Control Programme (NACP) in 2001. Since then, TB-HIV activities have continuously in-line with updated scientific evidences. A National Framework for joint TB-HIV collaborative activities was developed, under which the National and State TB/HIV coordinating mechanisms were put in place. Service delivery level coordination mechanisms were also established at the district level. Components such as dedicated human resources, integration of surveillance, joint training, standard recording & reporting, joint monitoring & evaluation, operational research were strategically implemented and nationwide coverage was achieved by July 2012. The National level TB-HIV coordination committee (NTCC) and technical working group (NTWG) regularly monitor and suggest on key policies, related to TB/HIV collaborative activities. The key lesson learned from this experience is that collaborative TB/HIV activities can be scaled up successfully in concentrated HIV epidemic settings, if TB and HIV programmes share ownership of TB/HIV interventions (source: Scaling up of collaborative TB/HIV activities in concentrated HIV epidemic settings: a case study from India WHO:2015, WHO/HTM/TB/2015.05).
However, till now an estimated one quarter of HIV deaths in India is associated with TB co-infection. This is not acceptable! The interventions to reduce the burden of TB among people living with HIV include early provision of antiretroviral therapy (ART) for people living with HIV in line with WHO guidelines, and strengthening of the three I’s of HIV/TB response – Intensified TB case finding followed by high quality anti-tuberculosis treatment, Isoniazid preventive therapy (IPT) and Infection control for TB. There have been significant improvements in the above indicators in recent years. Intensified TB case finding has been implemented nationwide at all HIV Integrated Counselling and Testing Centres (ICTC) and ART centres. RNTCP has also endorsed prioritizing to rapid molecular test Xpert-MTB/Rif (CBNAAT) to all presumptive TB cases among PLHIV for early diagnosis of TB as well as Rif resistance.
Today, we at the Central TB Division (CTD) take pride in reflecting on our major accomplishments of placing 421 CBNAAT machines to aid in quick detection of TB among PLHIV. These machines have now reached government hospitals across India, and collocated with ART centres. Placing of more such machines is in the process.
Collaboration with Vihaan is indeed an advantage, as community-based outreach is the backbone of its care and support centres (CSC). An integrated approach will aid in expanding HIV-TB services for PLHIV communities. We need to collaborate not only at the national level, but at the state and district level also.
All stakeholders, including the Central and the State Government have and will continue to work in a collaborative manner to increase screening among PLHIV and ensure early detection and treatment of TB, immediate ART initiation of all PLHIV detected with TB and improve and sustain treatment adherence of HIV-TB co-infected clients. With this synergy, we will able to put this menace to an end. So let’s “Unite to End TB! TB Haarega, Desh Jitega.”
The author of this article is Dr Raghuram Rao, DADG (TB) at Central TB Division, Dte. General of Health services, Ministry of Health & Family Welfare.
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