ABSTRACT
BACKGROUND: In 2010, WHO expanded previously-recommended indications for anti-retroviral treatment to include all HIV-infected TB patients irrespective of CD4 count. India, however, still limits ART to those TB patients with CD4 counts <350/mm(3) or with extrapulmonary TB manifestations. We sought to evaluate the additional number of patients that would be initiated on ART if India adopted the current 2010 WHO ART guidelines for HIV-infected TB patients. METHODS: We evaluated all TB patients recorded in treatment registers of the Revised National TB Control Programme in June 2010 in the high-HIV prevalence state of Karnataka, and cross-matched HIV-infected TB patients with ART programme records. RESULTS: Of 6182 TB patients registered, HIV status was ascertained for 5761(93%) and 710(12%) were HIV-infected. 146(21%) HIV-infected TB patients were on ART prior to TB diagnosis. Of the remaining 564, 497(88%) were assessed for ART eligibility; of these, 436(88%) were eligible for ART according to 2006 WHO ART guidelines. Altogether, 487(69%) HIV-infected TB patients received ART during TB treatment. About 80% started ART within 8 weeks of TB treatment and 95% received an efavirenz based regimen. CONCLUSION: In Karnataka, India, about nine out of ten HIV-infected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. ART could be extended to all HIV-infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.
Subject(s)
Antiretroviral Therapy, Highly Active/statistics & numerical data , HIV Infections/complications , HIV Infections/drug therapy , Practice Guidelines as Topic , Tuberculosis/complications , World Health Organization , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , India , Infant , Infant, Newborn , Male , Middle Aged , Registries , Time Factors , Young AdultABSTRACT
During the 1980s and 1990s, Uganda faced a severe crisis, with almost 30% of the adult population infected with HIV/AIDS. Uganda responded through a mix of rationalist and creative policy approaches which, after a decade of intervention, made Uganda the first African nation to report a decline in HIV prevalence--a trend that continues till today. Uganda thus demonstrated to the world that success is possible in the war against HIV/AIDS. I analyse here the Ugandan response to the HIV/AIDS epidemic and highlight some lessons to be learnt for countries such as India, which face a rising HIV/AIDS epidemic. It is in the creative policy initiatives, often called the unwritten policy response, that major lessons are to be learnt from Uganda. Lessons may also be learnt by other nations from certain weaknesses in the Ugandan approach.
