Speaking at the conference Dr Alasdair Reid, TB advisor at UNAIDS said the ‘three I’s’ needed to be implemented as part of HIV programmes ‘ Isoniazid preventative therapy (IPT) for a six month period, intensified case finding and infection control, especially in high risk areas such as HIV care facilities, prisons, workplace settings and injecting drug user services.
IPT consists of taking one pill, an antibiotic called isoniazid daily for between 6 and 9 months to prevent the development of active TB. IPT has proven to be safe and effective at reducing the risk of active TB in people living with HIV. However, it is critical that those people who are given IPT have been screened properly for active TB.
If active TB is diagnosed they need to be given the appropriate treatment which involves different anti-biotics.
Despite the existence of a national policy for IPT in South Africa since 2002, less than 1% of people living with HIV receive IPT in South Africa.
Activists and health workers this week demanded that IPT be scaled up immediately in all facilities in all provinces.
¨A circular should be sent to all health workers reminding them of the national policy and encouraging them to implement it. Any revision of the national policy should not be used as an excuse for delaying implementation of the existing policy, ¨ the activists said in a memorandum handed over to the Western Cape health department.
HIV-negative people have a one in ten risk of developing active disease in their lifetime, however this risk increases to one in ten per year for HIV-infected people. People living with HIV have a weakened immune system, which allows TB to spread to other parts of the body and cause active TB disease.
In South Africa the Treatment Action Campaign last year criticized the very low use of IPT which they said reflects ‘the failure of the Department of Health to address the TB and HIV epidemics with the urgency they require’.
‘Resistance to the use of IPT in South Africa is largely due to the difficulty of ruling out patients with active TB. This kind of mistake could lead to the unintended treatment of active TB with isoniazid, which on its own cannot treat active TB,’ the Treatment Action Campaign said in a policy briefing last year.
This week activists and health workers marched in Cape Town repeating these calls.
They said that at all levels of the health system, the TB and HIV programmes needed to become integrated in their approach.
¨This must occur in the National Department of Health’s TB and HIV programmes, provincial programmes, district offices, health care facilities and communities. Policies and plans of the Department of Health should specify what will be done to integrate TB and HIV services.
¨In facilities, patients should be able to be screened, tested and treated for TB and HIV in one facility. All health facilities that provide antiretroviral treatment should also provide TB treatment. Where this is not possible, measures should be put into place to ensure efficient referral systems between TB and HIV services, ¨ the Call to Action said.