After a remarkable plenary session on the use and the future of antiretrovirals, another interesting session followed on TB and HIV management in high HIV prevalence settings. Interestingly, the provocative subject is how to move from TB/HIV“ collaboration” – widely perceived as the most common situation taking place in the field – to a real “integration” between the two programmes. And the moderator did not even spare the international agencies when he mercilessly reminded the audience that such integration does not exist in the two respective WHO departments.
The panelists presented various experiences from the field and discussed the state of the art of scientific knowledge on the subject. They recommended to always advocate for and adopt sound policies on TB/HIV but to avoid dogma and preconceived opinions, maintaining a questioning attitude in this fast-changing scenario.
Overall, there was a consensus among the presenters that the main “disadvantages” of fully integrating TB with HIV are two: one is the risk of nosocomial infections (or even outbreaks) that necessitate a well planned infection control strategy. The second is the intricate challenge in having a single reporting system for the two programs.
It is probably impossible – and to some extent counterproductive – to merge the two reporting systems into one, by possibly “sacrificing” some information that the national programs demand for and need. A substantial progress was achieved when HIV parameters were introduced in the TB registers and reporting formats. Additionally, the recently revised pre-ART and ART registers have incorporated the dynamics of TB status. Now data on the coverage of the routine TB clinical screening and the number of new TB cases occurring among patients on chronic care have been added.
However, there is still something missing in the monitoring of TB/HIV activities that would be worth collecting. TB and both ART and pre-ART patients are currently being assessed in cohorts and their outcome measured according to standardized categories. However, little is known about the outcome of co-infected individuals, since their details get mixed with the overall cohort they belong to. Though we recognize that there are still problems with the quality of data collection and analysis of both TB and HIV interventions, it would be extremely useful for program to gather data on the co-infected patients cohort, whose peculiarities are worth a separate analysis. The outcome of these patients and and the trend over the years could provide invaluable information and assist in elaborating and reviewing relevant policy documents.