TB and HIV/AIDS Collaboration in Ghana

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Rapidly spreading drug resistant communicable diseases and limited resources force providers to search for cost effective treatment and prevention resources.  One of the three biggest problematic communicable diseases, TB is a major public health issue in Ghana. According to the USAID Tuberculosis Profile for Ghana, there was an estimated 46,693 cases in 2006. Ghana set up a National TB Control Program (NTCP) in 1994 using DOTS (Directly Observed Treatment Short course) as the primary strategy to achieve TB control. Various DOTS centers were established, in some cases using already established public health facilities. By 2000, Ghana had achieved 100% DOTS coverage by WHO standards; however, DOTS quality in some public health facilities especially in rural districts is still questionable.

One major comorbidity among TB patients is HIV/AIDS. The Ghana Infectious Disease report by USAID states there is an estimated 16% HIV prevalence in TB patients.  According to the 2009 Global TB Control Report, 25% of TB deaths are HIV related. This number is double what was previously acknowledged. Ghana has a National AIDS Control Program (NACP) that was revitalized in 2000 and has implemented antiretroviral therapy at various HAART (Highly Active Antiretroviral Therapy) centers. Both TB and HIV programs run parallel with little collaboration, making it difficult for patients with TB/HIV to access timely and coordinated care.

Patients also face double stigmatization. They will go to DOTS centers for TB treatment and then to a different center for HIV services. In 2006, a TB/HIV collaboration policy to guide activities was developed by the Ghana Health Service organization.

Collaboration on TB/HIV has been a topic at multiple international events, such as the International AIDS Study Conference yet there are still gaps in implementing TB/HIV activities with negative patient impact. There is the need to have DOTS or HAART centers provide both services not only in the big cities but in rural areas to ensure patients complete their treatment successfully, and for HIV/AIDS and TB programs to collaborate in order to more efficiently utilize funds and resources.  The Ghana Society for the Prevention of Tuberculosis (GSPT) called for community organizations to take on educator roles and encourage individuals to become more aware of TB and HIV treatment.

In order to achieve better care for TB/HIV patients, collaborative services are needed between the two programs eliminating the need for two center visits. The NACP and NTCP need to increase collaboration thereby reducing competition for funding and other resources. These services need to be offered particularly in rural areas, where multiple clinic visits are a huge burden and noncompliance often leads to multi drug resistant TB. Joint efforts with patient advocacy groups such as Healthcare Links and community TB supporters will also strengthen the case for much needed collaborative action.

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2 Responses to “TB and HIV/AIDS Collaboration in Ghana”

  1. Marwan Haddad Says:

    Thank you for bringing to light a problem that is facing many developing countries that are devastated with the TB/AIDS epidemic.
    The emergence of multi-drug resistant (MDR) TB and the more lethal extremely drug resistant (XDR) TB is only going to spread and worsen both epidemics.
    I do believe it is time to stop thinking about TB and HIV/AIDS as two separate and distinct epidemics but really approach them as one epidemic. Neither one of these diseases has made such a distinction when it is attacking the population. If anything, TB and HIV seem to prefer to travel together. So why should the public heath and medical communities not approach these disease in the same way?
    Most countries already have the infrastructure set up for the TB programs, and instead of enhancing this infrastructure to include HIV programs, many separate HIV programs have sprung up independently of the TB infrastructure. It is time now to merge these programs, capitalize on the existing infrastructure, train the staff in both diseases, and treat these conditions from the same centers!
    If not, at this rate, TB and HIV separately and together are going to continue to decimate whole populations and countries.

  2. anneoshy Says:

    Thank you for bringing up this pertinent issue that is contributing to the
    increasing mortality rate in HIV/AIDS and TB patients in developing
    countries especially in Africa. For effective DOTS program in HIV patients with TB co-infection, their has to be collaboration among the health care givers and facilities.This would ease the burden of attending two separate clinics at two different sites thereby reducing non compliance to drug use leading to multi-drug resistant and extremely drug resistant TB.This two diseases amplify each others impacts, TB increases the risk of HIV progressing to AIDS and the presence of HIV worsens TB. PLWHA(people living with HIV/AIDS) an HIV/AIDS support group should liase with the HIV and TB clinics to integrate their systems.Other stakeholders such as PEPFAR(president emergency fund for AIDS relief) could build model collaboration centers for other HIV treatment centers to follow.There is natural synergy and complementariness of TB and HIV programs which the WHO is asking Govts to take advantage of.There’s is less need for manpower in the collaboration than in running individual centers and better follow up of patients with co-infection.The National TB/HIV collaborating unit should revive all infrastructures set up for this purpose.With all these in place I believe there would be a decrease in the morbidity and mortality of the affected patients

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