title: A systematic review of missed opportunities for improving tuberculosis and HIV/AIDS control in Sub-saharan Africa: what is still missed by health experts?
abstract: In sub-Saharan Africa, HIV/AIDS and tuberculosis are major public health problems. In 2010, 64% of the 34 million of people infected with HIV were reported to be living in sub-Saharan Africa. Only 41% of eligible HIV-positive people had access to antiretroviral therapy (ART). Regarding tuberculosis, in 2010, the region had 12% of the world's population but reported 26% of the 8.8 million incident cases and 254000 tuberculosis-related deaths. This paper aims to review missed opportunities for improving HIV/AIDS and tuberculosis prevention and care. We conducted a systematic review in PubMed using the terms 'missed'(Title) AND 'opportunities'(Title). We included systematic review and original research articles done in sub-Saharan Africa on missed opportunities in HIV/AIDS and/or tuberculosis care. Missed opportunities for improving HIV/AIDS and/or tuberculosis care can be classified into five categories: i) patient and community; ii) health professional; iii) health facility; iv) local health system; and v) vertical programme (HIV/AIDS and/or tuberculosis control programmes). None of the reviewed studies identified any missed opportunities related to health system strengthening. Opportunities that are missed hamper tuberculosis and/or HIV/AIDS care in sub-Saharan Africa where health systems remain weak. What is still missing in the analysis of health experts is the acknowledgement that opportunities that are missed to strengthen health systems also undermine tuberculosis and HIV/AIDS prevention and care. Studying why these opportunities are missed will help to understand the rationales behind the missed opportunities, and customize adequate strategies to seize them and for effective diseases control.
authors.affiliation: Ministry of Public Health, Cameroon ; Research, Education, and Health Development Group (GARES-Falaise), Dschang, Cameroun.
authors.forename: Basile
authors.initials: B
authors.lastname: Keugoung
authors.affiliation: Research, Education, and Health Development Group (GARES-Falaise), Dschang, Cameroun ; Yaoundé Central Hospital, Yaoundé, Cameroon.
authors.forename: Florent Ymele
authors.initials: FY
authors.lastname: Fouelifack
authors.affiliation: Ministry of Public Health, Cameroon.
authors.forename: Richard
authors.initials: R
authors.lastname: Fotsing
authors.affiliation: Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Jean
authors.initials: J
authors.lastname: Meli
authors.affiliation: Public Health Department, Institute of Tropical Medicine, Nationalstraat Antwerp, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D017954:Africa South of the Sahara / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy
keywords: HIV/AIDS; Missed opportunities; health systems; sub-Saharan Africa; tuberculosis