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New England Journal of Medicine. 2008 Mar 13; 358(11):1089-1092.Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by a generalized human immunodeficiency virus (HIV) epidemic and compounded by weak health care systems, inadequate laboratories, and conditions that promote transmission of infection, this devastating situation has steadily worsened, exacerbated by the emergence of drug-resistant strains of tuberculosis. Africa, home to 11% of the world's population, carries 29% of the global burden of tuberculosis cases and 34% of related deaths, and the challenges of controlling the disease in the region have never been greater. The World Health Organization (WHO) estimates that the average incidence of tuberculosis in African countries more than doubled between 1990 and 2005, from 149 to 343 per 100,000 population (see maps) - a stark contrast to the stable or declining rates in all other regions during this period. In 1990, two African countries, Mali and Togo, had an incidence greater than 300 per 100,000; by 2005, 25 countries had reached that level, and 8 of them had an incidence at least twice that high. (excerpt)
Treatment strategies for HIV-infected patients with tuberculosis: Ongoing and planned clinical trials.
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S46-S51.Currently, there are limited data to guide the management of highly active antiretroviral therapy (HAART) for human immunodeficiency virus type 1 (HIV-1)-infected patients with active tuberculosis (TB), the leading cause of death among individuals with acquired immunodeficiency syndrome (AIDS) in resource-limited areas. Four trials to take place in Southeast Asian, African, and South American countries will address the unresolved question of the optimal timing for initiation of HAART in patients with AIDS and TB: (1) Cambodian Early versus Late Introduction of Antiretrovirals (CAMELIA [ANRS 1295/NIH-CIPRA KH001]), (2) Adult AIDS Clinical Trials Group A5221, (3) START, and (4) a trial sponsored by the World Health Organization/Special Programme for Research and Training in Tropical Diseases. Two other clinical questions regarding patients with TB and HIV-1 coinfection are also undergoing evaluation: (1) the benefits of short-term HAART when CD4 cell counts are > 350 cells/mm3 (PART [NIH 1 R01 AI051219-01A2]) and (2) the efficacy of a once-daily HAART regimen in treatment-naive patients (BKVIR [ANRS 129]). Here, we present an overview of these ongoing or planned clinical studies, which are supported by international agencies. (author's)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2004. 44 p.This framework, which draws on the Global strategic framework to reduce the burden of TB/HIV and on the Guidelines for phased implementation of collaborative TB and HIV activities, was developed based on the following two premises. First, the National TB Programme (NTP) needs to address the impact of HIV, i.e. higher caseload of TB and increasing drug-resistant TB, and to mobilize resources related to TB/HIV activities. Second, the National AIDS Programme (NAP) needs to prolong the life and reduce the suffering of PHA through better management of TB, and to mobilize resources for TB/HIV. The Regional framework is built on the strengths of the individual National TB and AIDS Programmes, and identifies areas in which both programmes complement each other in addressing TB/HIV. This approach is considered useful, not only for countries with a relatively high prevalence of HIV, such as Cambodia, but also for most of countries in the Region that are faced with a relatively low prevalence of HIV. The scope of the Regional framework comprises interventions against tuberculosis (intensified case- finding and cure and tuberculosis preventive treatment) and interventions against HIV (and therefore indirectly against tuberculosis), e.g. comprehensive prevention, care and support, including condoms, sexually transmitted infection (STI) treatment, safe injecting drug use (IDU) and antiretroviral (ARV) treatment. Key components of the Regional framework are: surveillance; diagnosis and referral, including voluntary counselling and testing (VCT) for HIV; interventions; and, areas of collaboration. The framework outlines the roles of the individual TB and HIV/AIDS programmes (i.e. “who does what”) and provides examples of how to operationalize the different components. (excerpt)
Journal of the Pakistan Medical Association. 2003 Aug; 53(8): p..How many private practitioners (PPs) listening to usual complaints of 'fever, cough and weakness for over two weeks' consider a diagnosis of active tuberculosis? In Pakistan, where TB is endemic and has assumed large proportions, the diagnosis would be considered and correctly treated by only a small percentage of PPs. A study recently conducted by the authors in Karachi showed that only 66% PPs ordered sputum microscopy as the preferred method for diagnosing TB. Only 50% thought themselves as capable enough to treat patients with pulmonary TB. Only 21% doctors prescribed a correct regimen in accordance with NTP or WHO guidelines. In such circumstances, if the PPs are treating 80% of patients presenting to them with tuberculosis1, one can imagine how worse the situation can get. Despite the fact that World Health Organization (WHO), in its effort to control TB, declared it a global emergency in 1993, TB still continues to account for the largest burden of mortality by any infectious agent worldwide. It is the second leading cause of adult death in impoverished communities of Karachi. Globally, Pakistan ranks 8th in terms of estimated number of cases by WHO, with an incidence of 175/100,000 persons. Pakistan alone accounts for 44% of total TB burden in the Eastern Mediterranean Region of the WHO comprising 23 countries. (excerpt)
JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE. 1995 Jun; 1(5):34.Tuberculosis (TB) is the leading killer, globally, of persons who are infected with human immunodeficiency virus (HIV); however, few countries are prepared to deal with this. In response, research experts on acquired immunodeficiency syndrome (AIDS) and TB met the first week of June to identify the best way to improve TB control in areas where HIV is prevalent or increasing. Dr. Arata Kochi, Director of the Global TB Program of the World Health Organization, warned that TB would kill almost one-third of those infected with HIV and would infect many of their contacts, both negative and positive for the virus, as the incidence of HIV rose in Asia. By the end of the decade, around one-third of all deaths among HIV-positive people will result from TB, according to Global TB Program estimates. In Abidjan, 32% of AIDS cases were considered to have died from TB. HIV is spreading more rapidly in Asia, where TB is more widespread than in Africa. Anthony Harries, a physician at Queen Elizabeth Central Hospital in Malawi, states that the co-epidemic complicates efforts to care for AIDS patients and to identify and treat TB patients. While caseloads are increasing, health workers are faced with a shortage of manpower and funds and a lack of appropriate technology. The meeting was convened by the Global Tuberculosis Program.