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ART coverage in TB/HIV patients increased in sub-Saharan Africa
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The percentage of reported HIV-positive patients with tuberculosis receiving ART increased from 37% in 2009 to 69% in 2013, CDC researchers reported in MMWR.
“TB is the leading cause of death among persons living with HIV in sub-Saharan Africa and remains a potential risk to the estimated 35 million persons living with HIV globally,” the researchers wrote. “ART reduces the incidence of HIV-associated TB disease, and early initiation of ART after the start of TB treatment reduces progression of HIV infection and death among HIV-positive TB patients.”
WHO recommends the scale-up of collaborative TB/HIV activities, including the provision of ART for HIV-positive patients with TB. The researchers evaluated progress in providing ART to these patients in 19 countries in sub-Saharan Africa that are supported by the President’s Emergency Plan for AIDS Relief (PEPFAR). Data was obtained from WHO’s global TB database.
From 2009 to 2013, the proportion of patients with TB being tested for HIV in these countries increased from 58% to 80%. With the greater detection, there was an increase in the proportion of HIV-positive patients with TB receiving ART, from 37% in 2009 to 69% in 2010. However, approximately 128,000 HIV-positive patients with TB in these countries still did not receive ART in 2013.
Because TB detection and reporting are incomplete, the number of reported patients is significantly smaller than the estimated number. When calculating ART coverage using the estimated number of HIV-positive patients with TB instead of the reported number of patients, only 38% of these patients received ART in 2013.
In PEPFAR-supported countries, ART coverage among reported patients in 2013 ranged from 37% in Ghana to 88% in Malawi. Seventeen of the countries provided ART for at least 50% of the patient population. Based on estimated patients, ART coverage ranged from 9% in Nigeria to 59% in Malawi, with only four countries reaching 50% ART coverage.
“The TB and HIV syndemic continues to pose a challenge to global public health,” the researchers wrote. “Although there have been substantial gains in global TB control and in expansion of HIV care and treatment programs, many countries with high rates of TB and HIV have not yet reached treatment targets. To achieve the vision of an AIDS-Free Generation and a world with zero TB deaths, concerted efforts are needed to close the ART coverage gap among all persons with TB disease and HIV infection.”
Disclosure: The researchers report no relevant financial disclosures.
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