Integrating services can help improve diagnosis and treatment for people with HIV and tuberculosis

Dauseni William Pallangyo, a farmer in Tanzania, coughed for months. His chest hurt, he was feverish, and he would wake up at night sweating. He wondered if he might have tuberculosis (TB), HIV, or both. His uncertainty kept him from seeking help.

Finally, Dauseni went to a hospital for treatment. A health worker diagnosed him with TB and recommended that he also be tested for HIV. The hospital offered free TB and HIV services, so Dauseni was tested for both in the same visit.

He soon learned he was HIV-negative. Dauseni started taking anti-TB medication, and his condition began to improve.

Integrated services for TB and HIV

Dauseni is among a growing number of people who are benefiting from integrated TB and HIV services. Because HIV infection weakens their immune systems, people living with HIV are particularly susceptible to becoming sick with TB disease—a condition called TB/HIV co-infection. TB is more difficult to diagnose in people with HIV, but because these patients become sicker more quickly it is critical to identify them early. In countries like Tanzania, TB is the leading cause of death among people with HIV.

In Tanzania, PATH supports the country’s National TB and Leprosy Program to implement TB and HIV activities in 35 districts across the country. We help to bring TB and HIV services together in one facility and ensure access to testing and drug supplies, making it easier for people to get all the care they need in just one place.

Solutions for a dual epidemic

PATH works closely with national and local governments, nongovernmental organizations, community-based organizations, and communities themselves to combat HIV and TB. We help create effective strategies to generate awareness about the dual epidemic. We also work to reduce stigma that may prevent people from seeking testing or treatment.

To help people who live far from diagnostic centers, we train community volunteers to collect and transport samples of sputum to test for TB. These volunteers, called sputum fixers, educate people about TB and TB/HIV co-infection, and refer them to health facilities for care.

With our partners, PATH also:

• Provides training for health care providers in counseling, testing, treatment, and support for people who have TB and HIV.
• Procures essential drugs, supplies, and test kits.
• Engages private-sector providers in identifying TB and TB/HIV cases earlier.
• Strengthens infection control systems in health facilities to protect workers and patients from airborne TB infection.
• Coordinates with governments to bring together members of national TB programs, national AIDS programs, and civil society to ensure coordination between TB and HIV services and communities.

Expanding care in Tanzania

PATH’s efforts in Tanzania focus on improving the lives of people like Dauseni by integrating high-quality TB and HIV services. We work closely with the Ministry of Health and other partners to train and mentor health care providers on providing coordinated services for people suffering from both TB and HIV.

Just 10 percent of patients with TB were screened for HIV in Tanzania when PATH began our project in 2005 with funding from the US Agency for International Development. Now, almost 90 percent of TB patients at nearly 1,000 health facilities in the districts where we work also receive HIV testing.

More training and improved care and testing are having a significant impact on the health and lives of Dauseni and others. Dauseni finished his treatment for TB, and today he is well on his way to recovery. He has resumed farming and is earning a living for his family, without the burden of poor health.

Photo: PATH/Darin Zehrung.