Background: TB/HIV Co-infection in Zambia
Zambia is in the midst of concurrent TB and HIV epidemics. The country has the sixth highest TB incidence worldwide (680/100,000) and an HIV prevalence of 15.6% countrywide, 22% in the capital, Lusaka. Pilot studies estimate that 54-70% of TB patients are infected with HIV, but it is unknown what the prevalence of TB is among HIV-infected persons. Prompt and accurate diagnosis of both HIV and TB in co-infected patients is critical as TB is a leading cause of death among HIV-infected persons.
The TB/HIV Program at the Centre for Infectious Disease Research in Zambia (CIDRZ) is working with the Zambian Ministry of Health (MoH) to improve care for TB/HIV co-infected patients and scale-up TB/HIV care and integration activities in Lusaka, Eastern, Western, and Southern provinces.
Goals of CIDRZ TB program
- To reduce the burden of TB and HIV/AIDS in Zambia by improving clinical care of TB/HIV co-infected patients and
- operational and clinical research on how to best accomplish this in a cost-effective manner appropriate for resource limited settings.
The TB Program works closely with the ART program to scale-up access to HIV testing for TB patients and improve care and diagnostics for TB/HIV co-infected patients in Zambia. The program is composed of both service and research arms:
Service Activities
- Improving TB diagnosis and clinical care in HIV-infected patients: CIDRZ offers clinical care training in TB diagnosis and clinical management of co-infected patients. CIDRZ has introduced new TB diagnostic workup sheets and referral forms into Lusaka HIV Care and Treatment clinics.
- HIV Diagnosis in TB-infected patients: Diagnostic Counseling and Testing (DCT) or “opt-out HIV testing” has been implemented in TB clinics in order to diagnose and refer HIV-infected TB patients to HIV Care and Treatment clinics.
- Systems development & implementation: Referral and communication systems between the vertical TB and HIV programs were established to facilitate and monitor appropriate co-management of patients infected with both TB and HIV.
- Lab services: CIDRZ recently purchased a florescence microscope and Bactec MGIT automated TB culture instrument in order to improve the sensitivity of TB diagnostic tests available to patients at HIV Care and Treatment Clinics.
- Training: In partnership with the MOH, CIDRZ offers training to district health staff regarding TB/HIV integration and encourages all clinic staff to learn and perform new skills in order to counter current health care worker shortages.
- Community: Improving community understanding of the interaction between TB and HIV, including social and cultural issues around TB/HIV co-infection, will be an increasingly important focus