Winning the fight against TB/HIV co-infection in Kazakhstan

Published: 20 March 2008 0:00 CET

Catherine Mears, Senior Health Advisor, British Red Cross and Marie-Françoise Borel, Federation, Geneva

TB/HIV co-infection has become a public health emergency in many countries. According to the World Health Organization, 700,000 people living with HIV developed tuberculosis in 2006. Some 14 million adults are co-infected in the world, and of the 1.6 million who die of tuberculosis each year, some 200,000 are HIV-positive.

An increasing number of Red Cross and Red Crescent Societies are integrating tuberculosis control in their HIV programmes at the community level, with good results.  Their activities complement the work of formal health systems by delivering care and support “beyond the clinic door”, giving the poor and the marginalized essential access to health services, often in rural areas.

One such successful programme is managed by the Kazakh Red Crescent Society.

Sergei has been a “client” of the Kazakh Red Crescent Society (KRCS) since 2006. Former prisoner, drug user and diagnosed with HIV, he also contracted tuberculosis (TB). After years of being “sent from one office to another”, as he puts it, the assistance and support he is receiving from the KRCS is really making a difference in his quality of life.

“When the Red Crescent project opened, doctors advised me go there. I did not go at first because I thought it would be as usual. However I did go there eventually and I liked it very much. The staff were very friendly and explained clearly who they are and what they do,” he says.  

“I got lots of support from the lawyer who helped me with documents related to my housing problems. All this was free of charge, and it was especially important as I do not work because of my health status. Through the project I also learned a lot about my health that I did not know before, such as the meaning of viral load, about combining ARV treatment with a DOTS treatment and managing side effects.”

Sergei is one of dozens of “clients” receiving integrated TB/HIV care from the Kazahk Red Crescent. In Kazakhstan nearly 46% of HIV-positive people are diagnosed with TB. They are much more likely to develop TB, which is an opportunistic disease, because of a depressed immune system. In Kazakhstan, more than a third (36%) of people living with HIV die of TB.

The Kazakh Red Crescent has been implementing its TB/HIV integrated programme in the towns of Almaty, Temirtau and Karaganda since 2005. The programme targets those with co-infection who are considered most likely to default on their treatment. Proper use of TB drugs and completion of treatment are essential not only for patients to be cured, but also to prevent the development of multidrug-resistant tuberculosis (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB), forms of the disease which are much more difficult and expensive to treat, and with lower rates of cure. Tuberculosis is curable, even among people living with HIV.

The programme provides clients and their families with psychosocial, legal, medical advice and peer support, as well as monthly food parcels, in order to maintain adherence to treatment and promote positive living. Clients are usually referred by the AIDS Centres and may also come on their own. Nearly three quarters of clients (74%) are former prisoners of which 52% are injecting drug users and homeless.

“I am also happy with the assistance that we receive monthly. It includes food parcels and hygiene articles, and it is a strong support for us in keeping up the treatment. I became more concerned about my treatment and even quit smoking,” notes Sergei. “I would say that projects like this are necessary for people like me and others as well. We feel that we are not ignored and that we are still wanted in society.”

This important work is supported by AstraZeneca PLC, a leading pharmaceutical company, under its long-term partnership with the British Red Cross.

“We are very grateful to AstraZeneca for supporting this vital project,” says Richard Radnor, Senior Corporate Partnerships Executive of the British Red Cross.  “AstraZeneca has been a generous supporter of our work in TB and TB/HIV prevention and control since 2002 and this project represents just one of many the company is supporting in Central Asia and sub-Saharan Africa. In this time we have been able to make a real and positive impact on thousands of people’s lives.” 

As of September 2007, the collected data points to the success of the programme. It is estimated that the programme covers approximately 65% of co-infected people. The treatment completion rate is reported (among the clients on treatment) to be 66%, and defaulter rate is down to 13% in 2007, compared with 33% in 2006.

There is an informal atmosphere between clients and Red Crescent staff and volunteers  - to date, 18 volunteers within the project have been recruited from the client group as volunteer peer supporters. A small ‘drop in’ centre has been set up, where clients can discuss their particular issues and constraints at their convenience, in individual and group consultations with multidisciplinary teams which include psychologists, lawyers and social workers. The programme also facilitates access to medical consultations for reviews of treatment regimens or advice on side-effects of treatment.

Educational activities on the diagnosis and treatment of TB as well as the promotion of safer sexual and drug use behaviour – to reduce further transmission of both TB and HIV -are also included, mainly targeting injecting drug users or sex workers.