Despite numerous declarations, pledges and promises, international agencies such as the World Bank, Pepfar, UNAIDS and WHO have failed to ensure that all people living with HIV (PLWHA) have access to TB screening and prevention. We are calling for an end to MOSOTOS and for global leaders to start living up to their promises.
One in four deaths among PLWHA is caused by tuberculosis. Despite being the leading infectious killer of PLWHA, the percentage of people with HIV who are regularly screened for TB has increased from 0.6 percent to only 4.1 percent in 2004.
The MOSOTOS campaign has been spreading around the AIDS Conference and has now been adopted by other civil society groups who share our frustration with endless commitments that are not translated into improved health outcomes for the world’s poorest and most marginalised people.
Our alternative conference newsletter has proved to be popular with participants, as has our MOSOTOS mascot. Although it has been delivered in a light-hearted way, our message is very serious: just talking about scaling up TB-HIV services without action or sufficient resources is unacceptable.
At a press conference yesterday, we launched our TB-HIV report card which highlights the screening scandal. Panelists agreed we need to start calling the failure to screen PLWHA for TB what it is: ‘malpractice’ and a denial of human rights. Dr Anthony Harries from the International Union Against TB and Lung Disease explained just how straightforward TB screening is. Screening for TB simply involves regularly asking an HIV-positive patient if they are displaying any of the following four symptoms: a persistent cough, fever, night sweats and loss of weight. If the answer is no then they probably don’t have TB, but could be started on preventative therapy which is useful to reduce the high risk of contacting TB in HIV-positive patients. If some of the symptoms are present then the patient should be tested for TB and be given appropriate treatment and care.
Early diagnosis and treatment of TB can result in many needless deaths being prevented. Thabile Dlamini, Deputy General Secretary of the Treatment Action Campaign (TAC), spoke at the press conference about how she had been misdiagnosed for TB many times herself. Similarly her brother was started on TB treatment late following numerous misdiagnoses. After a few weeks on TB treatment his health did not improve and he was later diagnosed with multi-drug resistant TB. His diagnosis was too late. Thabile informed us that she had buried her brother just days before travelling to Vienna for the AIDS Conference.
As this tragic story illustrates, the failure of policymakers to turn words into actions has irreversible consequences for families and communities around the world. To stop people with HIV dying from TB, all HIV/AIDS programmes must screen for TB and implement the “3 Is” – intensified case finding, infection control and isoniazid preventative therapy.
Additionally, affected countries, donors and technical agencies must act to ensure universal access to quality TB-HIV care by 2015 – moving in coordination with the goal of universal access to antiretroviral therapy. This, of course, all requires extra resources. A key opportunity for donors to replace MOSOTOS with action will be to commit $20 billion at the Global Fund replenishment meeting in October.