The White and the Three-Letter Plague: Integration of TB and HIV Care in Sub-Saharan Africa

Abstract

Although sub-Saharan Africa contains approximately 12% of the world’s population, it hosts an estimated 68% of all living HIV-infected people (22.5 million persons) and 30% of annual cases of TB (4.4 million persons). In countries with an extended epidemic of both HIV and TB, both infections commonly affect the same individuals. However, TB care services (WHO’s Directly Observed Therapy Short Course) and HIV care services essentially function as separate vertical programs. In 2004, in an effort to improve the management and control of TB and HIV, WHO produced an Interim Policy on collaborative TB/HIV Activities with a range of measures to improve the integration of TB care into HIV treatment programs (intensified TB case finding, isoniazid preventive therapy and TB infection control in healthcare settings) and the integration of HIV care into TB treatment programs (HIV testing and counseling, HIV prevention, co-trimoxazole preventive therapy, HIV/AIDS care and support, and antiretroviral therapy). In this review, we describe and critically discuss the evidence relating to the implementation of the proposed collaborative activities in sub-Saharan Africa.