Four countries in the Asia Pacific region are piloting approaches to integrate HIV/AIDS and tuberculosis (TB) treatment, care and support services.

According to reports presented at the recent 7th ICAAP conference in Kobe, Japan, bringing together these two sets of activities at a country level is proving difficult. Because of the isolated and parallel nature of TB and HIV programmes, as well as the differences in practical approaches required to address the two diseases.

Cambodia, India, Indonesia and Thailand are among the countries that have carried out pilot initiatives to integrate TB and HIV in their existing systems, maximising existing resources in order to accommodate increasing numbers of people living with HIV/AIDS (PWHAs). The approach taken was holistic in the sense that community members other than those living were also encouraged to make use of the facility and get screened for tuberculosis.

The strategy and the circumstances under which countries should implement joint treatment programmes were recently recommended as part of an interim policy on collaborative TB/HIV treatment released by the World Health Organization (WHO).

Common to each of the pilot programmes in these four countries was the use of a voluntary counselling and testing (VCT) approach. Every person screened for TB is encouraged to get tested for HIV and vice versa. Diagnostic tests for TB are routinely offered procedures for all clients.

Under the new approach, HIV positive individuals are trained as TB educators together with other clients. Teaching materials are also made available. What interests people to avail of the TB services is the confidentiality of their identity, and the fact that they are allowed to view the tuberculosis bacteria under a microscope; allowing them to gain a deeper understanding that the bacteria is tiny and can be cured if antibiotics are taken as directed by the healthcare providers.

PWHAs are routinely put on TB prophylaxis, medicines that prevent the development of 'active' TB, while those who are diagnosed with TB are given treatment to cure the disease. Those clients exhibiting complications are referred to a government tertiary hospital. A referral system is put in place right from the start to ensure a continuum of care from the home to community and the hospital, including other social services.

Although complex at times, the pilot initiatives have shown that if TB and HIV are addressed together it can extend the lives of people living with HIV/AIDS. Clear national policies that would support TB and HIV programmes are required in order to sustain the initiative. Among other challenges is the absorptive capacity of the health providers, laboratory capacity and the quality of the laboratory procedures to maintain a higher level of services. Sustainable support for opportunistic infection medication and antiretroviral drugs, patient education and reasonable living conditions are also vital. Monitoring and evaluation are necessary in order the measure impact and aid the initiative by guiding its future directions and informing future adjustments to practical approaches.

TB is the number one killer of people living with HIV/AIDS. In Asia the countries with the highest incidence of TB are Cambodia, the Philippines and Indonesia and the majority of deaths among people with AIDS (PWHA) are tuberculosis-related.

Greater attention was given to the interaction between these parallel conditions when Nelson Mandela highlighted the issue during the 2004 International AIDS Conference held in Bangkok Thailand. He gave a personal testimonial of how tuberculosis had affected his health, his overall well being and part of his perspective on life.