Mr France K Morule added that key populations for TB services include people who share the same living space with confirmed TB cases; mine workers; correctional services staff and inmates; people living with HIV; people with diabetes; malnourished people; users of drugs tobacco and alcohol; mobile, migrant and refugee populations; and people living and working in poorly ventilated and overcrowded environments (including informal settlements).
Challenges remain
Many of the obstacles that impeded effective HIV-prevention and -treatment programs in 2000 still exist today. More than 60% of people living with HIV remain without antiretroviral therapy, including women and girls, men who have sex with men, transgender people, sex workers, young people, and people who use drugs and other marginalised groups remain under-prioritised in the response; investments in HIV prevention research appear to have flattened; and widespread violations of human rights including criminalisation continue to undermine effective responses, said Mr France K Morule.
Research needed for shorter regimens, reducing pill burden
In an exclusive media webinar on 11th July 2016 in lead up to TB 2016 and AIDS 2016 (watch webinar recording: http://www.bit.ly/jul16-recording), Nomampondo Barnabas was on the panel of experts. Nomampondo is presently the Civil Society Liaison Officer for International Union Against Tuberculosis and Lung Disease (The Union) based in Johannesburg, South Africa. She presented her patient's perspective in this webinar, sharing her experience of living with both diseases: HIV and TB.
Nomampondo said, "I was diagnosed with HIV in 1997. We know that with HIV advancing one of the leading opportunistic infections is TB. I was diagnosed with TB in 2006. Dr Fuad Mirzayev of WHO Global TB Programme has highlighted the importance of shorter, cheaper drugs. Back then in 2006 I had to take (because of my weight) 5 TB drugs, 5 antiretroviral (ARV) drugs, 2 antibiotics to prevent further infections, and other medications to prevent side effects. I want to emphasize on importance of accelerating research for shorter TB regimens and also for decreasing pill burdens. Longer regimens and huge pill burden are also responsible for those who are forced to interrupt treatment midway. Shorter regimens and reducing pill burdens are a major priority for researchers. Today I am on just one pill a day - this needs to become a reality for others too who deal with co-infections or co-morbidities."
The magnitude of the HIV and TB epidemics reduced South Africa's chances of achieving the MDG goals related to reversing the epidemics of HIV and TB and reducing maternal and child deaths. Therefore implementation of the NSP must assist South Africa to reach these goals. HIV and TB management must be mainstreamed into the core strategies of all relevant government departments in all spheres of governance, as many interventions lie outside the domain of health. The mainstreaming of HIV and TB into the core mandate of all government departments will lead to a streamlining of work, allowing them to make relevant policy decisions and interventions.
With a view to eradicate these diseases in future, a long-term plan that seeks to address social, economic and behavioural drivers of HIV, STIs and TB is being rolled out as part of the countries National Development Plan. This includes (i) addressing challenges affecting access to social services in informal settlements, and rural and hard-to-reach areas; (ii) strategies to address the vulnerability of migrant and mobile populations and substance abuse; (iii) interventions to address harmful gender norms and gender-based violence; (iv) lessening the impact of HIV, TB and STIs on orphans/children/youth ensuring that they have access to the social services they need, including basic education. It is also trying to reduce the vulnerability of young people to HIV infection by ensuring that they stay in school until grade 12. Besides this, a Stigma-Reduction Framework and the People Living with HIV Stigma Index is also proposed to be implemented nationally.
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