Scientists Offer Plan for Reducing Deaths Among HIV-Positive TB Patients
Although the goal of halving the number of global tuberculosis deaths put forth by the leaders of the G8 group of nations may not be "realistic," given the prevalence of HIV/AIDS and poverty in the developing world, such targets "could help tuberculosis control programs and health services to focus on the needs of patients by improving the quality of care offered," a group of seven international scientists writes in a Lancet opinion piece. The authors note that in some countries in sub-Saharan Africa, more than 70% of TB patients are HIV-positive, suggesting that reducing TB deaths "will require a strengthening of TB control efforts and research focused on improving the care of HIV-positive TB patients." Noting that HIV-positive TB patients have "much higher death rates" during treatment than HIV-negative TB patients, the authors present a plan to improve TB treatment for TB patients living with HIV in developing nations, including the following:
- Faster Diagnosis: The authors state that delays in diagnosis of TB among HIV-positive individuals may occur because of patient perceptions of the disease, fear of stigma and limited access to health facilities. Health facilities also face problems, including a lack of resources, a shortage of trained health personnel and poor diagnostic facilities. To assess the obstacles and possible solutions to these problems, the authors propose research to determine the link between diagnostic delay and HIV infection and the "possible role played by diagnostic delay in leading to death."
- TB Drug Treatment: The authors note that "some evidence" has shown that HIV-positive TB patients may have trouble absorbing anti-TB drugs, particularly rifampicin. The authors state that HIV-positive patients may better absorb rifampicin if they take the drug on an intermittent basis, but warn that "[c]areful clinical studies" need to be done to show whether such treatment is effective, and how long the drug regimen should last.
- Other Forms of Drug Therapy: The authors note that a study in the Ivory Coast evaluating the antibiotic cotrimoxazole yielded a "significant" reduction of deaths among TB patients taking the drug. However, "because of different prevalence of opportunistic infections and different patterns of resistance to cotrimoxazole by commonly occurring pathogens," it is not known whether the drug will produce the same results elsewhere. Other antibiotics, such as oral quinolones, and non-antibiotics, such as multivatamins, should also be studied. Even though antiretroviral therapy remains the treatment "most likely to have a major effect in reducing deaths from TB in HIV-positive individuals," the cost of such treatment is too high for most people in developing countries, the authors note.
- Quality of Care: The authors write, "Regular clinical care and treatment for HIV-related complications in patients on antituberculosis treatment may be far from adequate in resource-constrained health facilities in sub-Saharan Africa." They state that the "adequacy of clinical care" needs to be "formally documented," with a "particular focus on staff morale and motivation."
- Protection of Health Care Workers: Since health care workers are susceptible to TB, the authors advise further study on the degree of TB risk health care workers face. They also advocate the establishment of monitoring systems to evaluate risk management among health care workers.