From I-TECH comes the
TB Prevention Tool Kit
This toolkit has been developed to assist facility level administrators and health care workers in communities with a high prevalence of both TB and HIV to implement TB infection prevention and control measures..
Included in the toolkit is this,
Think TB in people with HIV. Whilst not directly concerned with IGRA or latent TB infection it does have some general applications eg TB Control programmes
TB control programmes generally rely on passive TB case finding – where the onus is on the individual with TB to come in for diagnosis and care.
There isn’t time for that in people with HIV, who are at much greater risk of getting TB
The recommendation is to adopt a policy of intensified case finding (ICF)
Studies have shown that early detection, diagnosis and treatment of TB can interrupt disease transmission by infectious cases
The problem is that, for a variety of reasons, ICF has not been widely implemented. One of the reasons for this was that there was no internationally recommended standardised TB screening tool, another that there are no international guidelines
Internationally-accepted guidelines lead to advocacy and training in the various WHO regions, then changes in national policies, and then finally implementation, monitoring and evaluation in individual countries. The absence of guidelines creates a vacuum in which various implementers adopt their own ICF strategies, but no one analyses the data in a uniform way.”
Failure to issue proper guidelines has resulted in a loss of confidence by those in TB control which, in turn, leads to an increase in disease
“People are dying unnecessarily with readily diagnosable TB disease,” said Dr Kimerling. “It is the health system that is failing them, not their willingness to get screened.”
From this one could draw the conclusion that an increase in TB is directly related to a failure by respective governments and policy makers to ensure that TB control is appropriate and effective.
