Speaking yesterday in Johannesburg at a conference dedicated to the issue of combating TB in the South African mining industry, Prof Gavin Churchyard, director of Aurum Health Research, said that, because ART prolongs life expectancy of advanced HIV patients (stage four sufferers), these individuals were more susceptible to opportunistic infections such as TB and pneumonia until their bodies had rebuilt their immune systems.
This scenario was observed in studies performed in Rio de Janeiro, in Brazil, and Abidjan, in the Ivory Coast, where there is access to ART and widespread uptake of the treatment. In both studies, TB rates worsened.
Churchyard said that to combat this, ideally, ART should be rolled out to patients in the earlier stages of HIV aids such as when their CD4 cell count is 350 or below. However, he recognised that this is not financially viable, particularly in South Africa.
He suggested that if Isoniazid Preventive Therapy (IPT) were used in treating patients in stages one, two and three of HIV, the risk of becoming infected with TB would be reduced by 60%. IPT is also a very cost-effective treatment, with the full-year course having a price tag of only R60 a patient.
TB rates were declining and then stabilised during the 20th century but this phenomenon was reversed in recent times due to the HIV/Aids epidemic. Miners are particularly afflicted due the levels of dust associated with the occupation and there is, thus, growing pressure to further reduce dust emission in underground mines.
However, Churchyard said that it is not HIV that is driving the TB scourge as is often thought.
“The burden of TB is borne by HIV-positive people but the transmission of the disease is performed by HIV-negative people,” Churchyard said.
This is because HIV-negative patients are remaining undiagnosed and consequently coming into contact with others.
In South Africa, TB accounts for twice as many deaths in the mining industry as mine accidents, and gold-miners, due to the high levels of exposure to silica dust, are the worst affected by the disease.
The Thibela TB Study, due to launch by end-April, is the first time the mining industry is collaborating in such a big way to prevent this disease.
The gold-mining companies, AngloGold, Gold Fields and Harmony, the labour unions, and Departments of Health, Labour, and Minerals and Energy will be working together on the project.
The project is being funded by the Consortium to Respond Effectively to the Aids/TB Epidemic (Create), which is in turn funded by the Bill and Melinda Gates Foundation.
There are currently two similar projects on TB being researched by Create, the Zamstar project in Zambia and Cape Town, and the Rio project in Rio de Janeiro, Brazil.
The study aims to reduce TB rates in communities with a high burden of HIV, and use the results to transform global policy.
The Global Fund to Fight Aids, Tuberculosis and Malaria is facing a shortfall just three years after its birth and needs donors to commit billions of dollars over the next few years, Reuters reports.
The fund was set up as an independent, transparent conduit for rich nations' aid against the big three killer epidemics, which together cause about six-million deaths a year.
The fund has been holding a meeting on funding replenishment in Stockholm this week.
The Geneva-based fund's chief Richard Feachem said in an interview that while donors have pledged $6-billion so far, it needs one third as much again to meet its current commitments.
Aids treatment especially is a long-term commitment and the fund needs to know how much financing it can count on in coming years instead of the "very ad hoc, insecure" pledges now made by donor nations on an annual basis, Feachem said.
"The shortfall in 2006 and 2007 is very substantial because up until now most donors have pledged year by year, they haven't made long-term multi-year pledges," Feachem said.
"It is merely optimism that the money will be available. This 'replenishment' conference will turn optimism into firm commitments and guaranteed long-term funding.”
Peter Piot, executive director of UNAids, said it is vital to predict fund flows so that "five years down the road we won't run into the situation where we have to tell patients 'I am sorry, we are running out of money', which is basically a death sentence."
Feachem noted that fighting Aids, tuberculosis and malaria is a prerequisite for reaching the UN Millennium Development Goals.
"You can't achieve the child mortality goal unless you fight malaria, because it is the main killer of African children. You can't achieve the education goal unless you control HIV/Aids because in Zambia it is killing school teachers at twice the rate that school teachers are being trained,” he said.
The Associated Press further reports the fund supports some 300 programmes in 180 countries.
"The value of these programmes is already $8-billion, so we have quickly become a large mechanism to finance the fight against Aids, tuberculosis and malaria," Feachem said.
"But in the future, we need substantial funds to be able to be predictable and sustainable.”