Re: Tb and HIV

[Guest guest]

Dear FORUM,

Refer to Doctor Bobby's posting on Tb and HIV,

You have been correct in pointing out the strong relationship between T.B and

HIV. I will like to share with you an important experience as a T.B. specialist.

After doing my Diploma in Tuberculosis form C.P.S. Bombay in 1989, I started my

private clinic in a small CIDCO township of New Bombay.

After starting the practice , the local men and women started coming to me with

their general problems like cough , cold fever. Women wanted treatment for their

UTI, STIs. And they refused reference to other specialists due to financial &

and other reasons. I have diagnosed many T.B. patients in the past and the cases

have increased many folds, but I have actually written a prescription for not

more than 15 patients in the last 16 to 17 years. Not that I am not confident of

treating a T.B. patient but because I had been directing them to DOTS centers

where they could get free treatment.

The various pharmaceutical company representative tell me how come I don’t have

T.B. patients flocking my clinic, and how come all the rest of the doctors in

our township have “given so many ANTI T.B. drugs prescriptions” in a year? I

tell them that if I have rich patient I will write a prescription otherwise I

will rather send the patient to the DOTS center nearby ( which was in a next

node that time, this year we have got the first DOTS center in Kalamboli) and

see to it that he /she doesn’t default due lack of money which happens with

other doctors’ patients . The money thus saved can be used by them for the

patients high protein diet ( eggs, meat, pulses, and not the expensive protein

powders made by various pharmaceutical companies)

For many years, we , the doctors have not been vigilant enough and therefore,

have a very srong role in the development of MDR TB due to the above mentioned

reason. At least I have got many TB drug defaulter patients with this specific

reson that the physician who started the therapy did not counsel the patent

about the total cost of the therapy. And as if that is not enough, now I have

many patients coming in my HIV hospice O.P.D. who have defaulted ART, not due to

side effects, not due to any other reason but because they did not know that

they would be left with no food to eat once they started ART.

Now, is it not the hopeless situation we are creating for our own people? Every

doctor wants to treat TB and HIV patient, whether he is qualified or not. And

even if a qualified physician is treating the patients, he finds it below his

dignity to refer the patients to free DOTS or ART center.

Does any one have any solution to this mad self created problem by us medical

fraternity?

Dr. divya mithel

E-mail: <d_mithel@...>

[Guest guest]

Dear FORUM,

This is in responce to Dr. Bobby 's mail on HIV/TB. We really need to give

more focus on the HIV TB co-infection as people living with HIV with less cd4

counts are more likely to get TB infection and it is life threatening if goes

undiagnosed and untreated on time. We should incorporate TB diagnositis and DOTs

program in all the HIV/AIDS prevention and care programs.

PCI/India is implementing a Comprehensive Home Based Care Program in

collaborations with local partners in six cities in India where we are working

with RNTCP and incorporated DOTS within our CHBC program in Pune and it saves

lives. We have 10 DOTs Centres in Pune where our CHBC team are trained in TB

symptoms identification and referrals for testing. DOTs medicines have been

brought from the RNTCP centres and the team directly observe the theraphy for

those with TB. We also do ART referral, treatment literacy and follow ups.

best wishes,

Celina DCosta

e-MAIL: <dcostacelina@...>

[Guest guest]

Dear Forum,

This is in response to all the people who expressed their views on integration

of HIV and TB. HIV and TB co-infection is very common in india. It is good we

have to initiate or need to come out how to treat the PLWHas with TB

coinfection.

But no body is given taught how to do a follow-up of these clients.

In both HIV and TB it is essential the PLWHAs who put on ART or anti TB drugs

need to be carefully monitored to see that the person is adhere to treatment

and also provide an essential continum of care to improve the quality of life of

PLWHA.

The time has come to integrate these services with District Level Positive

People network.

It is essential all the departments like ART roll-out center, DOTS center, other

NGOs and State AIDS control society and positive people network sit together and

develop a plan how to put more number of PLWHAs on ARTor Ant-TB and also need to

evolve a startegic plan how to do the follow-up of cases.

Secondly there has to be some mechanism to monitor or carry out some sample

based studies to know the outcome of this integrated approach.

This integrated approach would defintely will help in reaching more people and

results in expected outcome of the programme.

thanks to forum for giving me an opporunity ro express my views

Bharat Shetty,

State Co-ordintor

Population Foundation of India

Bangalore

E-mail: <bharatwrites2001@...>