Track C report by Christopher Hurt
Anthony Harries, with the International Union Against Tuberculosis and Lung Disease, spoke about the importance of TB/HIV coinfection and moving research into policy and practice. The greatest burden of coinfection remains in sub-Saharan Africa, accounting for 80% of all cases worldwide. Despite the expansion of ARV coverage, many Africans die in the first year after starting therapy – often due to undiagnosed or unrecognized TB infection. He outlined the 4 spheres of current work: case-finding and treatment of TB among HIV-infected persons; diagnosis of HIV among TB patients; delivery of HIV/TB services; and prevention of TB by early ARVs and isoniazid prevention therapy (IPT). Dr. Harries provided detailed discussions of recent advances and current evidence within each of these spheres.
Judith Currier from UCLA discussed research on aging and the long-term complications of HIV disease. As treatment coverage continues to expand, bringing with it increased life expectancy, the epidemic is aging. Substantial proportions of the HIV-infected population will be over age 50 over the coming years. With aging, there are increases in non-communicable diseases affecting virtually every organ system. She outlined the epidemiology and pathogenesis of some non-communicable diseases of aging, such as cardiovascular and bone disease, along with some specific interventions for persons living with HIV.
Yogan Pillay, from the National Department of Health in South Africa, spoke on the progress being made in delivery of health services and integrating different types of services in South Africa. He discussed the need to encourage country-by-country ownership of individual HIV responses, optimize spending and improve efficiency of service delivery, focus on structural costs, and maintain strong relationships among all the principal stakeholders.
LAPC report by Esuyemi Ogunbanke
After IAS research awards were delivered, presentations were made on; TB and HIV, Aging and HIV and more effective Service Delivery
- TB deaths can be reduced through diagnosing for HIV and earlier treatment.
- As treatment expands life expectancy of PLWHAs, managing non-communicable diseases is a growing challenge.
- To meet targets for an AIDS free generation, we have to be more efficient and effective with national programmes.
1 Internationally, TB causes one in four HIV deaths. Reducing mortality requires persons diagnosed with TB be tested for HIV and vice versa. ART should be started earlier. Going forward, better, quicker cheaper tests are needed. Treatment for TB should be automatic for persons with advanced HIV. TB and HIV treatment centres should be collocated. Multi-disease campaigns should be rolled out to communities. Tackle poverty which is at the root of TB & HIV.
2 PLWHAs are living longer and becoming susceptible to non-communicable diseases (NCD). 11 percent of new infections are in persons over 50. Interventions include; early diagnosis and prompt care, earlier start of ART, tailor ART regimen to reduce risk of NCD, integrate screening and care for NCD into HIV settings. PLWHAs continue to maintain healthy diet and exercise.
3 Projections for the cost of measures to reduce the prevalence of HIV and AIDS are very high and this can be addressed by implementing programmes as efficiently as possible. Tactics include: integrate HIV into health services, target spending on drives which reduce mortality and incidence, remove parallel structures or stand alone services, fund improvements in technical efficiency of services, cut overheads. In additional to increased efficiency, political will and strong government ownership will effect change.