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HIV
/ TB Co-infection
As the epidemic of HIV is
mushrooming it becomes necessary to intensify our efforts in
developing strategies for providing supportive services to HIV
infected persons. HIV infection has escalated the burden of
TB, especially in countries where prevalence of HIV infection
and TB infection is high. Though the exact number of HIV-TB
infected persons is not known,
HIV infection is the most
powerful risk factor for progression from TB infection to
disease. An individual with dual infection of HIV-TB has more
than 50% lifetime risk of developing TB as compared to 10% in
TB infected person without HIV infection. The rate of
progression of TB is also 30 times more rapid in an HIV
infected person. TB accelerates the progression of HIV by
causing a six-seven-fold increase in viral load. It shortens
the survival period of an HIV infected individual and is a
cause of death for one in three cases of AIDS.
In a developing nation like
ours, the burden posed by increasing number of HIV/AIDS and TB
cases overwhelm our available services and budget. It is
therefore time for both the AIDS and TB programme to jointly
make efforts to deal with the dual epidemic of HIV and TB.
In India, more than 60% of
the reported AIDS cases suffered from TB. Though the life of
an HIV infected individual appears bleak due to lack of
definitive treatment or vaccine, what is encouraging to note
is that TB can be cured by treatment with Directly Observed
Treatment Short Course (DOTS). Treatment with DOTS prolongs
and improves the quality of life.
Recognizing this serious
threat posed by HIV and TB, the State of Maharashtra has
initiated the collaboration of the AIDS and TB Control
Programme.
State
Core-Committee for HIV-TB Co-ordination
Following the First National
Level Meeting on HIV-TB at New Delhi on 8th June 2001,
Maharashtra was the first State to form the State
Core-Committee for HIV-TB co-ordination. The State Core
Committee for HIV-TB co-ordination was formed under the
Chairmanship of Principal Secretary, Public Health. The
committee comprises of Director General of Health Services,
Director of Medical Education and Research, Project Directors
of AIDS Control Society, State TB Officer, Executive Health
Officer (Mumbai), Representative of ESIS, Members of AIDS
Control Society and Mumbai District TB Control Society, WHO
Consultants with Additional Project Director of Maharashtra
State AIDS Control Society as Member Secretary.
The State HIV-TB
co-ordination Committee reviews the performance of HIV-TB
activities in the State, formulate strategies for
strengthening the HIV-TB co-ordination activities, provides
technical guidance and takes policy decisions for
implementation of the HIV-TB activities in the State.
District Co-ordination Committee for
HIV-TB
As the implementation of the
HIV-TB activities started, a need was felt for District
Co-ordination Committee. District Co-ordination Committees
have been formed in all the districts of Maharashtra. The
State Government of Maharashtra has issued a government
Resolution for Constitution of District Co-ordination
Committee. The District Co-ordination committees headed by The
Regional Deputy Director Health Services with District TB
Officer as Member Secretary comprises of Civil Surgeons,
District Health Officers, Medical Officer Incharge VCTC, City
TB Officer, Blood Transfusion Officer, STD Medial Officer,
District Publicity Officer, Representatives of NGO's
implementing NACP and RNTCP.
VCTC-RNTCP
Co-ordination
Voluntary Counselling and
Testing Centres (VCTC) were established over varying periods
of time between the years 2001-2002. Today we have 57 VCTC's
in Maharashtra with atleast a minimum of one VCTC in each
district of Maharashtra. The VCTC's are located either in the
district hospitals, corporation hospitals or the Microbiology
department of medical colleges.
Co-ordination between VCTC
and RNTCP is beneficial to both HIV and the TB programme.
Voluntary Counselling and testing center (VCTC) can be a key
entry point for providing services for TB to all the HIV
infected persons. Apart from those who are HIV infected, a
large number of HIV negative persons benefit from the services
provided by VCTC. The benefits of detecting TB early are two
fold; better quality of the life for the individual and
reduction in number of TB cases. Providing information on TB
to all clients attending VCTC will ensure that the client is
aware of symptoms of TB and the facilities available for TB.
All VCTC's are provided with
a directory of Sputum Microscopy Centres and DOT Centres, as a
ready reference for referring the client to a center closest
to his residence. Posters on TB are provided to VCTC and are
displayed in VCTC along with the posters on HIV-AIDS.
Participation
of NACP NGO's in RNTCP
NGO's implementing Targeted
Interventions are also participating actively in RNTCP. Though
majority of them are identifying and referring suspected TB
cases to Microscopy Centre, some NGO's are also providing
DOTS.
Joint
Regional Review Meetings
One of the important areas is
co-ordination between the Voluntary Counselling Testing Centre
and Revised National TB Control Programme. Apart from
reviewing HIV-TB activities in the programme meetings of RNTCP,
quarterly review meetings of VCTC-RNTCP co-ordination
activities have been initiated. These meetings with the
District/ City TB Officer, Medical Officer Inchange VCTC and
VCTC Counsellor are conducted under the Chairmanship of State
TB Officer. Each district's performance on HIV-TB
co-ordination is reviewed meticulously and actions for
strengthening the HIV-TB co-ordination is discussed. The joint
regional review meetings have helped to strengthen the
linkages between the VCTC and RNTCP.
Consistent Co-ordinated
Efforts by AIDS and TB Control Programme will definitely go a
long way in combating the dual epidemic of HIV and TB
programme. Both the programmes will reap the benefits of their
Efforts. Increased awareness about HIV will decrease HIV
infection. It will blunt the increase in TB cases due to HIV.
Early diagnosis and prompt initiation of TB treatment will
improve the quality of life and longevity. Therefore let us
not be bogged down by AIDS and TB; instead let us rise
together to synchronize our efforts for strategic
confrontation of the dual menace.
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