Abstract
In sub-Saharan Africa, HIV/AIDS and tuberculosis are major public health problems. In 2010, 64% of the 34 million of people infected with HIV were reported to be living in sub-Saharan Africa. Only 41% of eligible HIV-positive people had access to antiretroviral therapy (ART). Regarding tuberculosis, in 2010, the region had 12% of the world's population but reported 26% of the 8.8 million incident cases and 254000 tuberculosis-related deaths. This paper aims to review missed opportunities for improving HIV/AIDS and tuberculosis prevention and care. We conducted a systematic review in PubMed using the terms ‘missed’(Title) AND ‘opportunities’(Title). We included systematic review and original research articles done in sub-Saharan Africa on missed opportunities in HIV/AIDS and/or tuberculosis care. Missed opportunities for improving HIV/AIDS and/or tuberculosis care can be classified into five categories: i) patient and community; ii) health professional; iii) health facility; iv) local health system; and v) vertical programme (HIV/AIDS and/or tuberculosis control programmes). None of the reviewed studies identified any missed opportunities related to health system strengthening. Opportunities that are missed hamper tuberculosis and/or HIV/AIDS care in sub-Saharan Africa where health systems remain weak. What is still missing in the analysis of health experts is the acknowledgement that opportunities that are missed to strengthen health systems also undermine tuberculosis and HIV/AIDS prevention and care. Studying why these opportunities are missed will help to understand the rationales behind the missed opportunities, and customize adequate strategies to seize them and for effective diseases control.
Highlights
Sub-Saharan Africa is the world's region most affected by HIV/AIDS and tuberculosis (TB)
This review identifies missed opportunities (MOs) to improve prevention, detection, diagnosis and adequate care of HIV/AIDS and TB in sub-Saharan African health systems
Many opportunities for improving TB and HIV/AIDS prevention and care are not seized by patients, populations, communities, health professionals, and managers of general health services and of vertical programmes
Summary
Sub-Saharan Africa is the world's region most affected by HIV/AIDS and tuberculosis (TB). In 2010, 64% of the 34 million of people infected by HIV were reported to be living in sub-Saharan Africa [1]. Only 23% of HIV-positive children had access to ART. This low access to prevention and treatment contributed to 2.7 million new HIV infections in 2010. Regarding TB, in 2010, subSaharan Africa had 12% of the world population but reported 26% of the 8.8 million incident cases -the world's highest incidence at 256 cases per 100000 inhabitants- and 254000 TB-related deaths. Sub-Saharan Africa counted for 82% of HIV-positive people with TB, and is the sole WHO world region that is not on track to halve the 1990 TB mortality by 2015 [2]
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