TB is the leading cause of illness and death among people living with HIV (PLHIV). It increases the occurrence of other infections, increases the rate at which HIV progresses, and influences antiretroviral therapy (ART) in various ways. Late diagnosis and delayed treatment of TB contributes to increased death rates in PLHIV.

A new strategy for tuberculosis control in high-HIV prevalence populations has been developed and the various approaches are summarised in Box 16.2.

If an HIV-positive patient develops symptoms of TB, it is essential you encourage them to seek treatment and refer them to a treatment facility.

Box 16.2 New strategies for dealing with TB/HIV co-infections

Activities directed against TB control are:

Intensified case finding (look actively for TB suspects and investigate for TB)
Treatment of TB cases (reduces risks of transmission)
Isoniazide Preventive Therapy (IPT) for patients who are HIV-positive but do not have an active TB infection. This is also recommended for children in contact with active pulmonary TB and children investigated for TB but found to be normal. This treatment prevents progression of TB infection to active disease.
BCG vaccine, given to children at birth. It is a modified 'live' vaccine for the prevention of severe forms of TB (TB meningitis, disseminated TB) which usually occur in childhood. It is one of the vaccines in Ethiopia's Expanded Programme of Immunization (EPI).
BCG vaccination is described in the Immunization Module.

Activities directed against HIV (and therefore indirectly against tuberculosis) are:

Safer sexual practices (e.g. use of condoms) to prevent transmission of the virus
STI (sexually transmitted infection) treatment to reduce the risk of transmission of HIV
Cotrimoxazole Preventive Therapy (CPT) prevents development of other opportunistic infections
Antiretroviral therapy (ART) to suppress HIV multiplication and increase natural immunity against TB infection.

All of these topics are covered in detail in the Study Sessions on HIV/AIDS in Part 3 of this Module