Medecins Sans Frontieres this month will assist three clinics in Swaziland's southern province of Shiselweni in providing services for people with HIV and tuberculosis coinfection, Inter Press Service reports. Aymeric Peguillan, MSF's head of mission in Swaziland, said the clinics will offer counseling, testing and treatment for both diseases because HIV and TB are "inseparable." He added that MSF intends to expand the program to include three more rural clinics within the next three months and hopes to work with all 19 clinics in the region by the end of 2009.
According to Peguillan, providing these services in rural clinics will "make it much easier to treat HIV/TB coinfection because services will be offered at one place and close to people's homes." Previously, people in the region needed to travel to distant hospitals to access HIV and TB services. The new program will link the clinics to an existing MSF project that provides rapid HIV tests and TB sputum tests at nine clinics and then transports the samples to hospital laboratories. By requiring the samples, rather than the patients, to travel, the program "minimize[s] the time and costs of accessing health services," Peguillan said. MSF also supplies clinics with antiretrovirals and TB drugs; however, many of these clinics lack sufficient medical staff, Peguillan said. He added that the organization hopes to train community members to assist clinic workers by providing HIV and TB counseling and testing, which will "increase the capacity of communities to help in the fight against TB and HIV/AIDS." MSF also promotes the recruitment of "expert clients" who have publicly disclosed their HIV status, to promote treatment literacy and positive living for people with HIV/TB coinfection, Peguillan said.
According to Themba Dlamini, National TB Program manager at Swaziland's Ministry of Health and Social Welfare, insufficient access to medical services and high transport costs to hospitals could account for low TB treatment adherence and increased prevalence of drug-resistant strains. According to Inter Press Service, the province has reported 40 cases of multi-drug resistant TB and two cases of extensively drug-resistant TB. In addition, the country has a TB detection rate of 57.7% -- 10% below World Health Organization guidelines -- and a TB treatment success rate of 42% -- nearly half of the WHO target of 85%. According to Peguillan, TB is the most common opportunistic infection among HIV-positive people in Swaziland. He added that the country's government will need to "take responsibility" for continuing to provide decentralized HIV/TB services for rural communities after MSF leaves Swaziland (Phakathi, Inter Press Service, 1/9).
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