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Special Communication
July 23 2008

Opportunities and Challenges for HIV Care in Overlapping HIV and TB Epidemics

Author Affiliations

Author Affiliations: Department of Medicine, University of California, San Francisco (Dr Havlir); Stop TB Department, World Health Organization, Geneva, Switzerland (Drs Getahun and Nunn); and Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa (Dr Sanne).

JAMA. 2008;300(4):423-430. doi:10.1001/jama.300.4.423

Tuberculosis (TB) and the emerging multidrug-resistant TB epidemic represent major challenges to human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings. Tuberculosis is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease, even after successful initiation of antiretroviral therapy (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population lags far behind global targets. HIV programs designed for longitudinal care are ideally suited to implement TB control measures and have no option but to address TB vigorously to save patient lives, to safeguard the massive investment in HIV treatment, and to curb the global TB burden. We propose a framework of strategic actions for HIV care programs to optimally integrate TB into their services. The core activities of this framework include intensified TB case finding, treatment of TB, isoniazid preventive treatment, infection control, administration of ART, TB recording and reporting, and joint efforts of HIV and TB programs at the national and local levels.

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