One Country’s Success and Mentorship in Fighting TB among those Living with HIV

Tuberculosis (TB) and HIV claim the lives of nearly 2.5 million people each year. In addition to being the top infectious disease killer, TB is also the number one cause of death for people living with HIV, accounting for more than 30 percent of all deaths.

The good news is we have powerful treatment and prevention tools that dramatically reduce these dire health outcomes: life-saving TB preventive treatment (TPT) can reduce the risk of developing and dying from TB disease among people living with HIV by 40 percent alone or nearly 80 percent when paired with medications that treat HIV.

However, TB preventive treatment has been under-utilized by national programs, which reached fewer than 20 percent of those in greatest need as of 2017. At the United Nations General Assembly High Level Meeting on TB in September 2018, more than 200 global health leaders and 65 organizations and nation states made a unanimous commitment to reach 30 million people with TPT by 2022.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) committed to leading the global scale-up of this life-saving treatment among those living with HIV and has urged country programs to make TPT available to everyone in their care.

One Country’s Success

One country has made extraordinary progress in the rapid scale-up of TPT and now serves as a model for implementation in other countries. Kenya has approximately 1.5 million people living with HIV (PLHIV). TB is the leading cause of illness and death for people living with HIV in Kenya. In fact, a quarter of TB patients in Kenya are co-infected with HIV.

After implementing an aggressive TPT scale-up effort, the number of people receiving TPT in Kenya increased 60-fold from just under 10,000 in 2014 to more than 600,000 in 2016. And by December 2018, Kenya had provided TPT to 85 percent of the one million Kenyans on life-saving HIV medication through PEPFAR-supported programs.

Sharing Solutions Across Borders

CDC staff visiting a lab in Kenya during the South to South Mentorship. Dr. Abraham Katana (center) from CDC Kenya provided visionary leadership for TPT scale-up in Kenya and encouraged the delegation to strive for the same in their countries

CDC Kenya and partners decided to build on their successes by hosting a workshop to share their experiences with neighboring countries, who are also battling the dual epidemics of HIV and TB. In May 2019, CDC Kenya hosted three delegations from the ministries of health (MOH) of Uganda, Zambia, and Zimbabwe to showcase Kenya’s dramatic success. In addition, staff from CDC and the Center for Health Solutions joined the delegations. Through site visits and hands-on workshops, the delegations identified which interventions from Kenya might address some of the challenges they face. Each delegation developed an implementation plan for TPT rapid scale-up in their own countries and received shared commitment from MOH and U.S. Government agencies to support these efforts. Dr. Herman Weyenga CDC Kenya’s technical TB advisor commented that “TB elimination is closer in view if countries overcome unfounded fears and take bold steps to translate TPT policies into action in line with PEPFAR commitment.” The gathering, dubbed the South-to-South Mentorship, was the first large-scale workshop of its kind.

Uganda’s delegation took their plan home to immediately engage both TB and HIV programs. They set up a task force and launched a 100-day campaign to place all eligible people with HIV on TPT. “The South to South learning exchange provided the spark to galvanize Uganda to take ambitious steps to improve TB diagnosis and prevention among people living with HIV,” said Michelle Adler, Health Services Branch Chief for CDC Uganda’s Division of Global HIV and TB.

The Impact of Committed Collaboration

delegation watches worker using medical record system

Visiting delegation learning from a site in Kenya how to track patients within their electronic medical record system that uses a biometric patient identification system. Dr. Herman Weyenga (center) from CDC-Kenya shared lessons learned and pitfalls from the Kenya TPT experience with delegation members.

Because of the strong commitment from political leadership and the technical expertise of their task force, Uganda is on track to reach their goal of initiating 300,000 people on TPT and ensuring that 90 percent of those started on TPT complete treatment by the end of the 100 day campaign in October.

The South to South Mentorship’s success involved the collaboration of a wide range of partners – from local advocacy groups and public health NGOs, to governmental officials and technical agencies who worked together to make sure the successful experience from Kenya of scaling-up TPT could be replicated in other high-HIV burden countries.