HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

Abstract

One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world’s population, had 17% of the global burden of HIV infection, and one of the world’s worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government’s response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.

The HIV-associated tuberculosis epidemic—when will we act?

“…[134][135][136] Moreover, isoniazid preventive therapy could further reduce tuberculosis incidence for those on ART. Worldwide, more than a third of the burden of HIV and almost half of the burden of HIVassociated tuberculosis is concentrated in southern Africa 137 -aff ected countries should examine such innovative strategies with urgency. Without imaginative use of available and potential strategies, the epidemic of HIV-associated tuberculosis will continue long term, robbing countries of years of productive and useful citizens' life.…”

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…8 South Africa has one of the worst tuberculosis epidemics in the world, with high disease burden, incidence rates, and HIV co-infection rates, and growing epidemics of multidrugresistant and extensively drug-resistant tuberculosis. 1 A recent report noted that about 28% of medical admissions in Edendale Hospital, KwaZulu-Natal, were for active tuberculosis and 26.5% of these patients died in this hospital. 4 The annual incidence of tuberculosis in KwaZulu-Natal was 1094 cases/100,000 in 2006.…”

Tuberculosis in Trinidad a Small Developing Country: Will we Reach the Millennium Development Goal 8 (MDG8) as we Countdown to 2015?

“…Antituberculosis drug resistance underscores the major deficiencies in current diagnostic technologies both for pathogen detection and for diagnosis of drug resistance [42]. Sputum culture and drug susceptibility testing are available in certain settings, but their impact is limited by the long duration and complexity of the laboratory processes [43].…”