By. Dr. Nneka Chukwurah

As I stepped out of the plane at Addis Ababa for the two day African Union member States meeting, I was optimistic that this meeting of Experts will develop a number of Policy instruments for consideration by the Ministerial session in Geneva in May 2016 which will culminate with the endorsement by the African Union (AU) Assembly in July 2016 in Kigali.

As I flipped through the meeting pack, my eye immediately caught one of the items on the agenda which is Catalytic Framework to end TB, HIV and Malaria in Africa by the year 2030.

Since TB and HIV are serious health problems globally, in Africa and Nigeria, I knew for sure that all the stakeholders need to take bold steps to end these diseases by thinking outside the box and working in synergy.

 Tuberculosis and the Human Immunodeficiency Virus (HIV) are among the 10 leading causes of death in Nigeria and indeed Africa, while HIV fuels the TB epidemic in immuno-compromised individuals, TB is the most common cause of death among People Living with HIV/AIDS (PLHIV) accounting for about one in five AIDS-related deaths.

It has been globally known that HIV infection greatly increases the risk of developing TB and people living with HIV are 29 times more likely to develop TB disease than those who are HIV-negative. 

Evidence suggests that the high HIV prevalence in Nigeria is a major driver of the high TB burden. A total of 590,000 TB cases were estimated to occur annually in the Country in 2014 (WHO Global TB report 2014), with HIV accounting for about 24% (140,000) of the total TB cases in 2014. Thus making HIV the highest population-attributable-fraction (PAF) for TB i.e. this implies that Nigeria could reduce TB by 24% just by controlling HIV.

As I sat through the conference, I had lots of take home that will form our next course of action that will see Nigeria adapting and adopting strategies to end TB in Nigeria. I thought of the catalytic approaches we need to employ to end TB and HIV by year 2030 which include the following:

There should be awareness on TB and HIV diseases particularly in the communities

Ensure that people know all the service delivery points

Ensure the capacity of health workers are built to offer TB/HIV services

Since we have identified that up to 24% of our PLHIV could have TB, our main approach will be ensuring that:

All PLHIV are screened for TB at every visit to the ART clinic; those who are symptomatic tested for TB using the GeneXpert machine.

All PLHIV who are positive for TB should be placed on anti TB medicine including patient’s education on TB and anti TB medicine and monitored during treatment to ensure that medicines are taken daily and laboratory tests done as at when due.

PLHIVs who do not have active TB (having asked the four cardinal questions of current cough, weight loss, excessive night sweat and fever) should be placed on isoniazid preventive therapy (IPT) to clear the TB infection in the lungs and prevent them from having active TB.

At the Directly Observed Treatment (DOT) centres, all presumptive and TB patients must be offered provider initiated testing and counseling (PITC).

All TB patients who are HIV positive must be started on ART between 2 and 8 weeks and must be placed on CPT as well.

Tools for documentation must be available and there must be correct and complete documentation on the necessary tools

Everyone with TB should have access to the innovative tools and services they need for rapid diagnosis, treatment and care.