Tuberculosis
Gaps in Research
- 1.
- Efforts are needed to reduce TB-related stigma for women.
- 2.
- Increased efforts are needed to actively plan for screening and treating HIV-TB co-infection, particularly in antenatal clinics.
- 3.
- Further research is needed to determine the appropriate timing of initiating ART for TB/HIV co-infected patients.
- 4.
- A combination of infection control strategies is needed to reduce the rate of TB transmission, especially in high-risk, low-resourced health care settings.
1. Efforts are needed to reduce TB-related stigma for women. A study found that in Malawi, TB-related stigma was closely linked with HIV; in Colombia, women faced work-related stigma; and in India and Bangladesh, women were concerned about the impact of TB on marital prospects and social isolation.
Gap noted, for example, in Bangladesh, India, Malawi and Colombia (Somma et al., 2008); Cameroon (Njozing et al., 2010).
2. Increased efforts are needed to actively plan for screening and treating HIV-TB co-infection, particularly in antenatal clinics. A study found no planning for HIV-TB co-infection across all levels of the health care system. Other studies found separate services and no information for co-infected patients on the risks of co-infection, plus no screening and treatment of co-infection. [See also Safe Motherhood and Prevention of Vertical Transmission ]
Gap noted for Vietnam (Conseil et al., 2010); South Africa (Kigozi et al., 2010); Swaziland (Elden et al., 2011); Ethiopia (Assefa et al., 2011a); and generally (Smart, 2012a).
3. Further research is needed to determine the appropriate timing of initiating ART for TB/HIV co-infected patients. Studies conflict with regard to timing of TB therapy and ART for those patients with CD4 counts below 200. Studies also conflict with regard to timing for ART for patients with extra-pulmonary TB.
Gap noted generally (Török and Farrar, 2011; Marais et al., 2010); Cambodia (Blanc et al., 2011); Vietnam (Török et al., 2011).
4. A combination of infection control strategies is needed to reduce the rate of TB transmission, especially in high-risk, low-resourced health care settings. [See Structuring Health Services to Meet Women’s Needs] “Early initiation of ART will significantly reduce TB incidence among people on ART, but additional interventions such as screening for TB using highly sensitive tools, preventative therapy, nutrition interventions, anemia, and poverty reduction may be needed to further reduce the burden of TB among people on ART” (Van Rie et al., 2011: 354). A study found that nutrition supplementation may increase patient survival and decrease the recurrence of TB among people living with HIV.
Gap noted generally (Van Rie et al., 2011); India (Sudarsanam et al., 2011).