Q. What is HIV/AIDS?
HIV is an infection caused by Human Immuno Deficiency Virus which decreases the immunity over a period of time and make person susceptible to gain infections which is an advance stage of HIV infection known as AIDS (Acquired Immuno Deficiency Syndrome).
Q. What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by bacterium ‘Mycobacterium tuberculosis’.
Q. What is the difference between TB infection and TB disease?
In TB infection, or Latent TB Infection (LTBI), the TB bacteria are in the body but inactive. A person with LTBI usually has a positive TB skin test and a normal chest x-ray. A person with LTBI does not have any symptoms of TB disease; and, this person is not sick and cannot spread TB to others. If an infected person's immune system cannot stop the bacteria from multiplying, the bacteria eventually cause symptoms of active TB which is called TB disease. Only 10% of all people with TB infection may suffer from the TB disease.
People with conditions like HIV, Diabetes Mellitus, Malnutrition and those on treatment with immunosuppressant drugs (anti-cancer, corticosteroids etc) are at a greater risk of developing TB disease once infected.
Q. What is risk of TB among People living with HIV infection?
Tuberculosis is a commonest opportunistic infection (OI) in HIV infected individuals, HIV infection is an important risk factor for acquiring TB infection and its progression to active TB. The annual risk of developing TB in persons living with HIV (PLHIV) who are co-infected with Mycobacterium tuberculosis ranges from 5% to 15%. Up to 60% of PLHIV develop active TB during their lifetime compared to about 10% of HIV-negative individuals. The risk of TB in HIV-infected persons continues to increase as HIV disease progresses and immunity decreases.
HIV/TB together is a deadly combination with extremely high death rates (15%- 18%) reported among HIV-infected TB cases notified under Revised National TB Control Programme (RNTCP). It could be fatal if not treated.
Q. What is the estimated burden of HIV and TB in India?
It is estimated that there are 2.1 million people living with HIV in India with an estimated adult HIV prevalence of 0.27% (range: 0.2%–0.4%).TB accounts for 25% of deaths among People Living with HIV and AIDS (PLHIV) in India. Though only 5% of TB patients are HIV-infected, in absolute terms it means more than 100,000 cases annually, India ranks second in the world and accounts for about 10% of the global burden of HIV-associated TB.
Q. What are the national priorities in TB/HIV as per National Frame work?
As per National Framework, 2013 the four pronged strategy include
- Early Detection of TB/HIV
- Prompt Treatment of TB/HIV
- Management of special TB/HIV cases
The National Framework emphasizes on 3I’s i.e.
- ICF: Intensified Case Finding at all HIV care settings
- IPT: Isoniazid Preventive Therapy
- IC: Air Borne Infection Control of TB at HIV/TB care settings
Q. What are the best practices to prevent TB among PLHIV?
- Intensified Case Findings (ICF) activities at all HIV care settings- ICTC, ART, LAC and TI settings
- Early diagnosis using rapid diagnostics for detection of TB and DR-TB in PLHIV
- Isoniazid Preventive Therapy
- Air Borne Infection Control
- Awareness generation regarding TB symptoms, services for prevention, diagnosis and treatment.
Q. What are the current diagnostic tools for diagnosis of TB/DRTB among PLHIV’s ?
- Sputum microscopy using BM, LED microscopes at Designated Microscopic Centres
- Cartridge Based Nucleic Acid Amplification Test (CBNAAT)
- X-Ray, including digital X-Ray facilities for Smear negative
- Culture & Drug Sensitivity Test (DST) facilities
- Biopsy, FNAC etc. for diagnosis of Extra Pulmonary TB
Q. Where is the HIV testing service delivery done for confirmed TB or presumptive TB cases ?
Provider Initiated HIV Testing and Counselling (PITC) of TB patients is now implemented across the country. It is critical that the offer of HIV testing should be done early after TB diagnosis and results are promptly communicated to referring provider so as to ensure early linkage to HIV care and support. Presumptive TB cases in A & B category districts are also referred to nearest ICTC/F-ICTC’s for HIV testing.
Q. Where can TB patient get his HIV test done?
HIV testing of TB patients should be done at NACO ICTC (stand-alone or F-ICTC or PPP ICTC & Mobile ICTCs). Patients screened for HIV using whole-blood finger prick test if found “non-reactive” do not require further testing, while if results is “reactive”, it should be confirmed at nearest ICTC.
Q. What are the TB/HIV co-ordination mechanisms in India?
National Level coordination mechanisms:
- National TB/HIV Coordination Committee(NTCC)
- National Technical Working Group (NTWG)
State level coordination mechanisms:
- State Coordination Committee (SCC)
- State technical Working Group (SWG)
District level coordination mechanisms
- District Coordination Committees (DCC)
- Monthly HIV/TB coordination meeting
Q. What are the activities undertaken for strengthening the TB/HIV collaborative services?
- Single window service delivery to HIV positive individuals through provision for Anti TB services at ART centres
- Intensified TB case finding by deployment of rapid molecular diagnostics, Cartridge based Nucleic Acid Amplification Test (CBNAAT). These rapid molecular diagnostics would be used as a primary diagnostic tool in 30 identified ART centres across five states - Andhra Pradesh, Telangana, Karnataka, Tamil Nadu and Maharashtra to improve diagnostic accuracy in HIV positive individuals
- Early identification, reporting and management of side effects of drugs through Pharmaco vigilance Program of India (PvPI)
- Treatment adherence support to patient including support through use of Information Communication Technology
- Provision of TB preventive Therapy to HIV infected individuals (Isoniazid Preventive Therapy)
- Minimization of risk of acquiring TB in HIV positive individuals through implementation of Air Borne Infection Control measures at these ART centres
The strong collaboration between NACP and RNTCP has helped in enhancing HIV testing coverage amongst notified TB cases and the Intensified TB Case Finding activities are being implemented amongst PHLIV in the country, with efforts to ensure universal access to HIV-TB collaborative services, while minimizing stigma and discrimination associated with HIV/TB.
Q. What are the TB/HIV co-ordination mechanisms to reduce burden of TB among PLHIVs?
- Isoniazid Preventive Treatment
- Air Borne Infection Control
- Awareness generation
Early Detection of TB/HIV
- 100% coverage of PITC in TB patients
- PITC in presumptive TB cases
- Rapid diagnostics for detection of TB and DR-TB in PLHIV
- ICF activities at all HIV settings -ICTC, ART, LAC and TI settings
Prompt Treatment of TB/HIV
- Early initiation of ART & Linkage to Co-trimoxazole Preventive Therapy (CPT)
- Prompt initiation of TB treatment irrespective of CD4 count.
Management of special TB/HIV cases
- TB/HIV patients on PI based ARV
- TB/HIV in children
- TB/HIV pregnant women
- Drug resistant TB /HIV cases by linking them to National Programmatic Management of Drug Resistance TB services (PMDT).
Diagnostic and treatment services for TB /HIV co-infected patients are offered free of cost at all nearest Government health facilities.