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Detection and treatment of tuberculosis and HIV in Latin America
“Alone, TB and HIV are leading causes of infectious disease deaths. Together, TB causes one third of AIDS-related deaths every year.” –WHO
In Central America, the burden of undetected/untreated tuberculosis remains high. Historically, TB and HIV tests have been conducted in different facilities, due to the region’s vertical disease program structure. The CDC-funded HIV Co-infection Surveillance Strategies for Program Planning in the Central America Region under PEPFAR (CDC-LAC) project works in Honduras, Nicaragua, El Salvador, Panama, and Guatemala to address some of the challenges related to TB and HIV coinfection.
The CDC-LAC project builds health worker capacity to increase the detection and treatment of tuberculosis and HIV. The project supports cross-testing—of people with tuberculosis in the general population for HIV and of people living with HIV for TB—within the healthcare system’s centers for TB and HIV diagnosis and treatment and fostering linkages to care. On-site trainings and a mentoring process conducted in TB clinics, HIV clinics, and laboratories ensures that healthcare workers in TB and HIV facilities are better equipped to identify patients and work to reduce the burden of these diseases.
Prior to the project, TB programs were neglected across the region (except in El Salvador, which had a strong TB program); HIV programs have been better staffed and funded over the past few decades. Staff turnover in HIV and TB clinics and laboratories is high due to poor wages—in some cases, even nonpayment of wages—and poor working conditions, including insufficient staff, materials, and medicines and lack of infection control in older buildings.
In 2016, three years into the project, staff in HIV clinics are screening for and referring patients for TB treatment. Staff in TB clinics have scaled up testing, detection, and treatment of patients with TB while adding protocols to detect HIV and link those patients to care.
Now, patients who test positive for HIV in TB clinics are linked to care early; asymptomatic HIV patients start isoniazid preventive therapy; and TB infection control measures are being implemented at both TB and HIV clinics. The project team provides training and follow up in nearly 60 health facilities every three months. This ongoing support, training, mentoring and systems strengthening empowers healthcare workers improve the quality of care they provide to patients in their facilities and supports efforts to prevent, treat and control these diseases.