COMDIS Co-Director John Walley Presents on TB/HIV Integration

28th October, 2009

COMDIS Co-Director John Walley presented on "TB/HIV integrated services planning: Lessons learned from Good Shepherd Hospital, Lubombo Region, Swaziland" to a panel of TB and HIV experts in London earlier this week.

His presentation focused on the need to integrate TB and HIV prevention and care at the hospital, health centre and community levels, in regions where both diseases are endemic. He spoke from personal experience about the challenge and ultimate success of implementing an integrated TB/HIV programme in Lubombo, Swaziland, from the bottom up. Swaziland has perhaps the highest rate of co-infection in the world, yet a very practical programme has significantly reduced the burden there, giving hope to other low-income countries.

Prior to the collaboration, wards at Good Shepherd Hospital in Lubombo - a large rural district hospital - were overcrowded with patients sleeping two to a bed. Transmission of TB and HIV between patients was high; patients were defaulting on their treatment plans, developing drug resistance, and often dying.

Pictures of the old and new waiting rooms.

 

Today, it is a different story. A new facility has been built that separates TB and HIV patients, and the hospital now tests every HIV positive person for TB and vice versa. This has allowed more infected patients to be identified and registered, supervised and treated. In addition, patients who are at risk of defaulting on their treatment, for example if they have missed an appointment, are visited by motorcycle riding adherence officers who drive to their home and ensure they get back on track.

While the most serious cases should be cared for at large hospitals like Good Shepherd, a COMDIS trial of follow-up care of patients on anti-retroviral treatment found that most TB and HIV patients can be more effectively cared for at their local health centres than in a hospital setting. Patients expressed better satisfaction with the level of care at the health centre, while drop out of treatment rates and death rates were equally good as hospital care. Treating more patients at the community level also makes it possible to reduce the levels of overcrowding at district hospitals and initiate more people on to life saving care.

At the grassroots level, family members play a vital role providing support to TB patients to ensure that they continue with their treatment, which lasts on average for eight months to ensure they are cured. Patients are also linked with volunteers who have had personal experience with TB and/or HIV infection and training as "expert patients", and can guide them through the process.

Following on the success of this in Lumbabo, the programme will be scaled up to support the National Government to cover the rest of the country so that it can be replicated elsewhere.

In addition to Professor Walley's presentation, several other speakers detailed their perspective on the need for increased TB/HIV integration, in technical as well as advocacy domains. Speakers came from organizations including Action for Global Health, Target Tuberculosis, Global Health Advocates, and the International HIV/AIDS Alliance.

Professor Walley's Presentation can be found here.