Joint tuberculosis/HIV services in Malawi: progress, challenges and the way forward

Linking HIV testing and treatment with TB services in Malawi

This article in the Bulletin of the World Health Organization reviews the progress made on a three-year tuberculosis (TB)/HIV plan implemented in Malawi between 2003 and 2005. The objectives of the plan were to scale up HIV testing among TB patients and, for HIV-positive TB patients, to provide cotrimoxazole preventive therapy (which provides protection against bacterial infections including pneumonia) and facilitate access to antiretroviral (ARV) treatment. The paper finds that the proportion of TB patients tested for HIV increased from 15 per cent in 2003 to 47 per cent in 2005. During this time, the majority of HIV-positive TB patients started cotrimoxazole preventative therapy.

Barriers to testing TB patients for HIV include: irregular supplies of HIV-testing reagents, staff forgetting to refer patients or patients themselves not undergoing HIV testing and counselling after being registered and placed on anti-TB treatment. The paper recommends that ways to improve HIV-testing uptake need to be found, including the integration of HIV testing into the TB registration process itself. The monitoring systems for HIV and TB need to explicitly include the relevant parameters, for example, TB monitoring tools which include data on numbers of TB patients who have been tested for HIV, who are HIV-positive, and who have started antiretroviral therapy.

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Joint tuberculosis/HIV services in Malawi: progress, challenges and the way forward