We Still Die of AIDS & TB!
AIDS – or advanced HIV disease (AHD) – means that a person’s CD4 count has fallen below 200 and they are more at risk of getting other illnesses. In South Africa almost a third of people living with HIV start treatment with a low CD4 count. The lower the CD4 count, the more at risk people are to get other illnesses and possibly die.
AHD is a major challenge for people starting treatment late, or restarting treatment after an interruption. A large proportion of people who die from AIDS sought care at our public health facilities – either at hospitals or at clinics – but healthcare workers failed to make a diagnosis. Many remain hidden deaths with no-one held accountable. Easier and quicker diagnosis and treatment needs to urgently be made available.
TB in particular remains the leading cause of illness and death among people living with HIV, especially people with AHD and those who are not yet taking ART. Although treatable, deaths remain high partly due to delayed diagnosis and treatment – often because symptoms of TB are regularly overlooked by healthcare workers, and the opportunity for early TB diagnosis and treatment is missed. Failure to quickly inform someone they have TB or cryptococcal meningitis, and get them started on treatment, cannot continue.
While South Africa has adopted a number of medical interventions to address AHD and TB, such as CrAg screening, TB LAM testing, and the roll out of TB preventive therapy, much more can be done to diagnose and treat the people who present with AHD, half of whom are missed with clinical staging/symptom screening alone as they enter care or re-engage.
TB infection control must also be improved to prevent the spread of TB at our clinics and hospitals. By following a simple checklist of good practice – including key measures that were successfully implemented during COVID-19 – facilities can be safer for public healthcare users and staff.
Since 2017, TAC has implemented an annual survey and traffic light system scorecard to rate clinics on how good their TB infection control is. It cannot be that our clinics are places where we can get TB.
