1School of Health and Medical Sciences, Örebro University, Örebro, Sweden
2Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
3Faculté des Sciences de Santé et Developpement Communautaires, Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
4Inspection Provinciale de la Santé, Goma, Democratic Republic of Congo
Background HIV/AIDS and Tuberculosis (TB) are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo.
Methods A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics.
Results Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities). Twenty-three facilities (29%) offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24%) reported some coordination with and support from concerned diseases’ control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes.
Conclusion HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region.
4. Lienhardt C, Ogden JA. Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm? Trop Med Int Health 2004; 9: 833–41. doi: 10.1111/j.1365-3156.2004.01273.x
5. Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, Chimzizi R, et al. The HIV-associated tuberculosis epidemic--when will we act? Lancet 2010 29; 375: 1906–19. doi: 10.1016/s0140-6736(10)60409-6
6. Spiegel PB. HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action. Disasters 2004; 28: 322–39. doi: 10.1111/j.0361-3666.2004.00261.x
7. WHO. Global Tuberculosis Control 2010. Geneva: WHO; 2010.
8. DRC. Democratic Republic of Congo Demographic and Health Survey 2007: Key Findings. [updated 2011 May 20; cited 2013 August 1]. Available from http://www.measuredhs.com/pubs/pdf/SR141/SR141.pdf
9. Prunier G. From genocide to continental war: The “Congolese” conflict and the crisis of contemporary Africa. London: Hurst; 2009.
10. Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet 2006; 367: 44–51. doi: 10.1016/s0140-6736(06)67923-3
11. Nyago K. Congo-Kinshasa: the forgotten holocaust. Monitor [serial on the Internet]. 2003. [updated 2003 May 20; cited 2013 August 2]; Available from: http://allafrica.com/stories/200305210486.html
12. Rossi L, Hoerz T, Thouvenot V, Pastore G, Michael M. Evaluation of health, nutrition and food security programmes in a complex emergency: the case of Congo as an example of a chronic post-conflict situation. Public Health Nutr 2006; 9: 551–6. doi: 10.1079/phn2005928
13. Ndongosieme A, Bahati E, Lubamba P, Declercq E. Collaboration between a TB control programme and NGOs during humanitarian crisis: Democratic Republic of the Congo. Bull World Health Organ 2007; 85: 642–3.
14. The Global Fund. Strengthening the Stop TB strategy in the Democratic Republic of Congo: DRC Proposal to the 8 Round for TB. The Global Fund, 2009.
15. Zachariah R, Harries AD, Manzi M, Gomani P, Teck R, Phillips M, et al. Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport. PLoS One 2006;1: e121. doi: 10.1371/journal.pone.0000121
16. WHO. Interim policy on collaborative TB-HIV activities. Geneva: World Health Organization; 2004.
17. WHO. WHO Tree I’s meeting. Intensified Case Finding (ICF), Isoniazid Preventive Therapy (IPT) and TB Infection Control (IC) for people living with HIV. Geneva: WHO HIV and Stop TB Departments ; 2008.
18. WHO. WHO policy on collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders. Geneva: WHO; 2012.
19. Spiegel PB, Bennedsen AR, Claass J, Bruns L, Patterson N, Yiweza D, et al. Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review. Lancet 2007; 369: 2187–95. doi: 10.1016/s0140-6736(07)61015-0
20. Human Rights Watch. The War Within the War: Sexual Violence Against Women and Girls in Eastern Congo. [cited 2013 August 1]. Available from http://www.hrw.org/reports/2002/drc/Congo0602.pdf
21. Omba Kalonda JC. [Sexual violence in the Democratic Republic of Congo: impact on public health?]. Med Trop (Mars) 2008; 68: 576–8.