A few months back, I noted the shocking statistics on tuberculosis, highlighting that one-third of the world’s population are infected and 1.7 million people die from the disease each year. This month’s tuberculosis (TB) conference, held in Durban, South Africa, highlighted the need for integration of TB and HIV care.
I met Prof Harry Hausler, the chair of the conference and medical director of TB/HIV Care, in March. His organization has been at the forefront of the integration movement, piloting and advocating integrated and community-based approachs to care. But he noted that the challenges are great: while TB stigma is declining, it is still a hindrance to early diagnosis and proper treatment. The WHO-endorsed DOTS (Directly Observed Therapy, Short Course) strategy for treatment has been successful, but it hinges upon the adherence of patients and a fully functioning system by which patients can access their health practitioner reliably and efficiently. Prof Hausler’s Project Integrate has been working to build the appropriate linkages between patients, communities, and health facilities, a complex set of interactions that require high levels of coordination in a fragmented system.
The separation of the two diseases is evidence that ministerial policies can greatly impact health approaches, even as political winds change. AllAfrica notes that: “former Health Minister Manto Tshabalala-Msimang [of South Africa] always favoured a separation of the two diseases, claiming that she wanted to spare those with TB from the stigma of AIDS.”