Setting the stage

I am currently in the throes of putting together a primer on the growing epidemic of Tuberculosis in immunosuppressed South African populations (as well as elsewhere in the developing world). As I am no expert on the subject myself, I have been spending a lot of time assembling the proper sources and trying to figure out the best way to organize the discussion to include my personal observations alongside the growing mountain of medical and public health literature on the subject.

I actually knew very little about the burden of TB in the developing world before I arrived here, except for the early (largely pre-HIV) work done by Paul Farmer and his wonderful organization, Partners In Health, in Haiti. There has been an infinite amount of material for me to absorb over these past few months – and as I am rapidly finding out, writing about these topics is a really good way for me to start to make sense of things.

So, while you wait for my more substantive piece, here are two abstracts regarding TB/HIV from recently published papers I have found to be extremely illuminating. I have the full text of both of these papers, so feel free to drop me a line if you’re interested in reading on.

Hope you guys all have lovely weekends, and I'll catch up with you again soon. Hamba kahle.

The Prevention and Control of HIV/AIDS, TB and Vector-borne Diseases in Informal Settlements: Challenges, Opportunities and Insights.

David AM, Mercado SP, Becker D, Edmundo K, Mugisha F.

J Urban Health. 2007 Apr 12; [Epub ahead of print]

Health Partners, L.L.C., Tamuning, GU, USA, amdavid@guamcell.net.

Today's urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today's urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the "social determinants of disease" model, preventing and controlling HIV/AIDS, TB and vector-borne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda.

Tuberculosis, Drug Resistance, and HIV/AIDS: A Triple Threat.

Friedland G.

Curr Infect Dis Rep. 2007 May;9(3):252-261.

AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2483, USA. gerald.friedland@yale.edu.


The worldwide epidemics of tuberculosis (TB) and HIV/AIDS have been joined by an insidiously developing third epidemic of TB drug resistance. Fueled by the disruption of TB control programs and the explosive growth of HIV/AIDS, the presence of TB drug resistance, particularly multiple drug resistance, is worldwide and threatens the gains made in the past decades in the treatment of both TB and HIV. Although treatment success is possible, the diagnosis and treatment of drug-resistant TB is difficult. Advances in TB diagnosis and treatment have been minimal in the past 40 years, and there is an urgent need for wider distribution of available diagnostic technology and for the development and testing of newer rapid molecular diagnostic techniques and therapeutic agents. This review discusses current information about the distribution of multiple drug-resistant and newer extensively drug-resistant TB as well as available diagnostic and therapeutic strategies with an emphasis on the relationship between TB drug resistance and HIV/AIDS.