Peter Wiessner

The UN HLM on TB in September this year creates a momentum for tuberculosis advocacy. The special session discussed current challenges in TB care in particular regarding available services, a better integration of TB and HIV services and the need for better integrated TB and HIV advocacy and activism.

Carol Nawina Kachenga, a patient advocate from South Africa, elaborated why 40% of TB cases, such as migrants, children, poor people, are not integrated into health system. Reasons are poverty, financial burden, lack of information, disintegrated services. For a patient disintegrated services cost time, energy and financial resources. Patients with co-infection such as TB and HIV and co-morbidities, like cancer currently visit 3 different clinics: an almost impossible burden for workers, care-takers, mothers. Blessie Kumar says TB and HIV integration is a must, not a choice: TB is globally one of the 10 leading causes of death; PLHIV are 26-31 more likely to develop active TB, nevertheless, out of 10.4 million new TB cases only 6.3 million are identified, there is a clear role for community-let responses. A lack of strong TB activism from the community was addressed: HIV and TB communities need to collaborate better.

Beside all diagnostic and medical challenges, related to research and development, access to treatments, affordable medicines, a stronger and integrated approach is needed. This applies to structures, service providers and community activism alike. Silos need to be overcome. The session addressed some of the problems but failed to identify clearly who benefits from the current disintegration, for example donors and companies. “Divide and rule” as the old Romans said, has deadly and powerful consequences. Communities should not allow this and drive their own, integrated, agenda.