PEPFAR support for the scaling up of collaborative TB/HIV activities.
The US President's Emergency Plan for AIDS Relief (PEPFAR) has supported a comprehensive package of care in which interventions to address HIV-related tuberculosis (TB) have received increased funding and support in recent years. PEPFAR's TB/HIV programming is based on the World Health Organization's 12-point policy for collaborative TB/HIV activities, which are integrated into PEPFAR annual guidance. PEPFAR implementing partners have provided crucial support to TB/HIV collaboration, and as a result, PEPFAR-supported countries in sub-Saharan Africa have made significant gains in HIV testing and counseling of TB patients and linkages to HIV care and treatment, intensified TB case finding, and TB infection control. PEPFAR's support of TB/HIV integration has also included significant investment in health systems, including improved laboratory services and educating and enlarging the workforce. The scale-up of antiretroviral therapy along with support of programs to increase HIV counseling and testing and improve linkage and retention in HIV care may have considerable impact on TB morbidity and mortality, if used synergistically with isoniazid preventive therapy, intensified case finding, and infection control. Issues to be addressed by future programming include accelerating implementation of isoniazid preventive therapy, increasing access and ensuring appropriate use of new TB diagnostics, supporting early initiation of antiretroviral therapy for HIV-infected TB patients, and strengthening systems to monitor and evaluate program implementation.
ICAP, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. aah2138@columbia.edu
Andrea A
AA
Howard
Michel
M
Gasana
Haileyesus
H
Getahun
Anthony
A
Harries
Stephen D
SD
Lawn
Bess
B
Miller
Lisa
L
Nelson
Joseph
J
Sitienei
William L
WL
Coggin
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D017954:Africa South of the Sahara / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D003906:Developing Countries; D014943:Global Health; D006801:Humans; D007391:International Cooperation; D009313:National Health Programs / Q000458:organization & administration / Q000639:trends; D055818:Public-Private Sector Partnerships / Q000458:organization & administration / Q000639:trends; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D014481:United States