MBABANE, 4 November 2009 (PlusNews) - Swaziland not only has the
world's highest HIV prevalence rate, it now also has the highest
tuberculosis (TB) rate, but health officials warn that not enough
is being done to integrate TB and HIV services.
Last week the Ministry of Health and Medecins Sans Frontieres
(MSF), the international medical humanitarian organization,
brought together health experts to look at practical solutions
for the small landlocked country.
One in four adults is infected with HIV; by the end of 2007 an
estimated 170,000 people were living with HIV, and every year an
estimated 13,000 people develop TB, the primary opportunistic
disease in HIV-positive people.
"When you look at the history of TB in Southern Africa you see
that it was considered a very serious disease in the 1950s, but
seemed to be under control by the 1980s; but with the arrival of
HIV and AIDS, TB rates have really gone out of control," said
Prof Alan Whiteside, head of the Health Economics and HIV
Research Division (HEARD) at the University of KwaZulu-Natal in
Themba Dlamini, manager of Swaziland's National TB Control
Programme, said 80 percent of Swaziland's TB cases were also
But with governments focused on HIV/AIDS, TB has not been getting
"Part of the problem is we've been very good at mobilizing for
HIV and AIDS, and we sort of forgot about TB as we did that.
Unfortunately, I don't think the people mobilizing for TB have
been as articulate and as powerful as those mobilizing for HIV
and AIDS - we need to put TB higher on the public agenda,"
Whiteside told IRIN/PlusNews.
Swaziland's Health Minister, Benedict Xaba, reminded delegates
that although the country provided free TB medicines, other
costs, such as hospital fees and transport, made it difficult for
many people to access health services.
"There are several issues that Swaziland needs to face. Access to
care is particularly important ... so people who show signs of
symptoms can be checked immediately. Free consultation is
absolutely imperative - we must think of free care from diagnosis
to clinical cure," urged Dr Mario Raviglione, Director of the
Stop TB Department of the World Health Organization (WHO).
Raviglione urged the country to step up efforts to integrate TB
and HIV services. "It doesn't make any sense for a person taking
TB drugs and ARVs [antiretrovirals, to treat HIV] to go to two
separate doctors. These must be integrated."
About 58 percent of TB patients completed their six-month course
of treatment last year, falling far short of the 85 percent
target recommended by WHO. International guidelines also set a 70
percent detection target for TB, but in Swaziland the case
detection rate is below 60 percent.
The good news is that, unlike HIV/AIDS, TB is curable. "I know
people living with HIV and TB, and their TB has been dealt with,"
noted Whiteside. "It is a community message we need to get out -
that we are capable of eliminating the scourge of TB in your