House of Commons - International Development

Select Committee on International Development Twelfth Report

3 Interaction with other diseases

Tuberculosis

39. A recent report by the House of Lords Select Committee on Intergovernmental Organisations, Diseases know no frontiers, recommended that "UK funding to combat HIV/AIDS in developing countries should be conditional on the adoption of an integrated approach to fighting TB-HIV co-infection."[64] Tuberculosis (TB) is the most common cause of death among people with HIV: about 13% of AIDS deaths each year are a result of co-infection with TB.[65] In sub-Saharan Africa up to 80% of TB patients are co-infected with HIV.[66] TB is much harder to diagnose in people living with HIV and someone who is co-infected with TB and HIV is much more likely to become sick with TB compared to someone suffering from TB alone. Currently less than 15% of TB patients in Africa are tested for HIV despite the high rate of co-infection.[67] The most recent data shows that only 1% of people living with HIV/AIDS are screened for TB; but of those who have been screened, more than 25% were found to have TB.[68] DFID's evidence indicates that only 42% of countries with generalised HIV epidemics screen for TB, and approximately one-third of affected countries does not have a national plan that integrates HIV and TB activities.[69]

40. Witnesses drew attention to the increase in multi-drug resistant strains of TB (MDR-TB) which make it more difficult and costly to deal with the impact of TB.[70] MDR-TB can result when TB treatment is incomplete or in cases where an incorrect or incomplete combination of drugs is prescribed. Treatment of drug resistant forms of the disease takes longer, and requires a higher quantity of more expensive drugs. Besides the added time and expense required for treatment, fatality rates are high. If a person has drug resistant TB, anyone they pass it on to will also have the same resistance. TB Alert says that a standardized drug regimen (known as "directly observed treatment") a good supply of high quality drugs, and isolation of infectious patients with drug resistant forms of the disease are some of the main ways to prevent the spread of MDR-TB.[71]

41. DFID argued in its written evidence that the best way to deal with the interaction between HIV/AIDS and other diseases is through an approach that focuses on strengthening health systems and services overall.[72] The main element of DFID's work to tackle disease interaction is therefore the £6 billion funding for strengthening health services which we have discussed above. In addition, DFID has already made a commitment to increase research into tools for the prevention, diagnosis and treatment of TB in its Research Strategy 2008-2013.[73] The £1 billion pledged to the Global Fund to Fight AIDS, TB and Malaria will also address the interaction between HIV and TB.

42. In its written evidence, the non-governmental organisation Results UK raised concerns that the Strategy failed to set out what measures DFID will take to address the interaction between TB and HIV.[74] The NGO is concerned that the Strategy provides no clarification on how DFID will fulfil its commitment to support "closer integration of AIDS, TB, malaria and SRHR [sexual and reproductive health rights] including maternal and child health services"[75] and no indication is given of how DFID will measure its effectiveness in tackling the interaction. Results UK suggested that meaningful indicators could include the proportion of TB patients being tested for HIV; and the number of people in HIV care who had started TB treatment.[76]

43. We also heard from Lucy Chesire, a Kenyan HIV-TB advocate, about the problems in the diagnosis of TB in people living with HIV. There is a reliance on outdated diagnostic techniques such as x-rays which are not sufficiently effective in identifying TB.[77] During our session with the Minister he stressed that "improving diagnostics is right at the heart of creating improved universal health systems."[78] However, while the Strategy acknowledges the importance of improving diagnostics, only one concrete funding proposal is made to increase general access to diagnostics, and this is limited to southern Africa.[79]

44. While the funding for health systems strengthening committed by DFID may well contribute to the treatment and diagnosis of patients with HIV and TB, we are not convinced that DFID is taking sufficient steps to ensure that the specific challenge of interaction between the two diseases is tackled. Nor has DFID set out how it will measure the effectiveness of its Strategy in addressing the interaction. We expect to see a clearer indication of how this work will be taken forward and measured in DFID's forthcoming Monitoring and Evaluation Framework.

Malaria

45. The interaction between HIV/AIDS and malaria also poses a serious challenge to public health in developing countries. People living with HIV/AIDS who become infected with malaria are more likely to develop severe manifestations of the disease such as anaemia and cerebral malaria. They are also less responsive to malaria treatment and have a higher mortality rate from the disease. Pregnant HIV-positive women with placental malaria infection are more likely to experience anaemia, adverse birth outcomes such as pre-term birth and intra-uterine growth retardation, and deliver a low-birthweight baby.[80]

46. The Malaria Consortium argued in its written evidence that the Strategy does not address the interaction between HIV and malaria.[81] DFID says that "stronger links must be forged between TB, malaria and HIV services",[82] but the Strategy does not elaborate on how such links could be forged. Nor does it explore the possibility of joint diagnosis for HIV and malaria.

47. At the UN High Level Event on the MDGs held on 25 September a Global Malaria Action Plan was announced. The Plan aims to achieve "near zero preventable deaths" by 2015, with the ultimate aim of eradicating the disease.[83] In support of the Plan, the UK has pledged:

£40 million for the Affordable Medicines Facility for Malaria
To increase funding for malaria vaccine research to up to £5 million per year by 2010; and
To provide 20 million of the 125 million bed nets that are needed to close the global shortfall in bed nets by 2010.[84]

48. The interaction between HIV/AIDS and malaria must be tackled as part of an effective AIDS Strategy. We welcome the commitments made by DFID in support of the Global Malaria Action Plan. It is not clear to us, however, how this important work on malaria will be integrated with the HIV/AIDS Strategy. We invite DFID to provide us with further information on this in its response to this Report.

64 House of Lords Select Committee on Intergovernmental Organisations , First Report of Session 2007-08, Diseases know no frontiers: How effective are Intergovernmental Organisations is prevention their spread?, HL Paper 143-I, p 48 Back

65 World Health Organisation, The Three I's: Intensified Care Finding (ICF), Isoniazid Preventive Therapy (ITP) and TB Infection Control (IC) for people living with HIV. Report of a WHO Joint HIV and TB Department Meeting, Geneva, Switzerland, April 2008 Back

66 Ev 35 Back

67 Ev 35 Back

68 Ev 84 Back

69 Ev 35 Back

70 Ev 55 Back

71 TB Alert: see http://www.tbalert.org Back

72 Ev 36 Back

73 DFID, Research Strategy 2008-2013, p 8 Back

74 Ev 85 Back

75 Achieving Universal Access, p 4 Back