AIDSWEEKLY Plus; Monday, May 9, 2005
Staff Medical Writers

"The World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target.

"ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003," investigators in Luxembourg report.

"Most TB patients leave the hospital after 2 weeks to complete the initial phase of antituberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ethambutol).

"ART is only offered at hospital, while the majority of TB patients take their continuation phase of antituberculosis treatment from health centers. HIV-positive TB patients therefore find it difficult to access ART," wrote R. Zachariah and colleagues at the Operat Research HIV TB in Luxembourg.

"In this paper," continued the authors, "we discuss a series of options to increase the uptake of ART among HIV-positive TB patients.

"The main options are: 1) to hospitalize HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralize ART delivery so ART can be delivered at health centers; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of antituberculosis treatment."

Researchers concluded, "Decentralization of ART from hospitals to health centers would greatly improve ART access."

Zachariah and colleagues published their study in International Journal of Tuberculosis and Lung Disease (Can we get more HIV-positive tuberculosis patients on antiretroviral treatment in a rural district of Malawi? Int J Tuberc Lung Dis. 2005 Mar;9(3):238-47.

For additional information, contact R. Zachariah, Operat Research HIV TB, Department Med, Brussels Operat Center, 68 Rue Gasperich, L-1617 Luxembourg, Luxembourg.

The publisher of the International Journal of Tuberculosis and Lung Disease can be contacted at: International Union Against Tuberculosis Lung Disease (I U a T L D), 68 Boulevard Saint-Michel, 75006 Paris, France.

Keywords: Luxembourg, Luxembourg, HIV/AIDS, Malawi, Tuberculosis, Antiretroviral Therapy, Drug Access.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Zachariah R, Teck R, Ascurra O, et al., Can we get more HIV-positive tuberculosis patients on antiretroviral treatment in a rural district of Malawi?, Int J Tuberc Lung Dis. 2005 Mar;9(3):238-47.

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