A Talk on Pediatric Tuberculosis and HIV
March 29, 2011
Last week marked World Tuberculosis (TB) Day
– a day to raise awareness of the dangerous spread of TB worldwide, particularly among children and families living with HIV.
Dr. Anneke Hesseling – Director of the Pediatric TB Research Program at the Desmond Tutu TB Centre
in South Africa, and a recipient of our International Leadership Award (ILA)
for research – visited the Foundation’s D.C. offices to update us on the promising results of her work focused on children with both TB and HIV, two intertwined issues. (Watch a video of Dr. Hesseling discussing childhood tuberculosis at the end of this post.)
Dr. Hesseling (center) discusses her latest research with
Foundation staff on World Tuberculosis Day. (Photo: EGPAF)
Preventing and treating TB infection in pregnant women and their children is an important and vital step in the fight against HIV/AIDS. As the leading cause of death among people living with HIV in sub-Saharan Africa, TB affects millions around the globe every year.
But TB in children remains a largely overlooked and neglected issue.
In South Africa – which has the fourth highest number of TB cases worldwide – children account for 16 percent of all TB disease. The percentage of those children who are also infected with HIV is high – ranging from 25 – 60%, depending on the region of the country. Dr. Hesseling is researching ways to identify, prevent, and treat infants, children, and pregnant women affected by these dual diseases.
Currently, methods to diagnose TB disease are not designed specifically with children’s needs in mind. Medicines to treat TB in children also lag behind the treatment options available to adults, and are often difficult to give to young children. This highlights an urgent need for additional pediatric research and drug development, especially for very young children.
Children living with HIV have a much greater risk of getting TB after being exposed. They also have a higher risk of dying of TB – in part because early detection is difficult, their immune systems are weaker, and treatment options are more limited.
That’s another reason why early treatment with antiretroviral therapy is essential for these children – it not only manages their HIV infection, but also dramatically reduces their risk of getting TB.
In addition, HIV-positive pregnant women are ten times more likely to contract TB, and those who do have TB have a greater likelihood of passing HIV on to their infants through mother-to-child transmission. TB infection also leads to a much higher mortality rate for both mothers and babies.
It’s clear that in sub-Saharan Africa, HIV and TB can’t be looked at in isolation – where you find one, you’ll most likely find the other.
Dr. Hesseling explained that the risk of TB among children and HIV-positive women could be greatly reduced by improving integration of TB services within existing programs to prevent mother-to-child transmission (PMTCT) of HIV, as well as within broader maternal and child health services. The Foundation is doing just that in many of its programs, such as a project in southwest Uganda
which combines services for both diseases into one integrated package of care.
Dr. Hesseling also recommended increasing screenings of HIV-positive pregnant women for TB and expanding TB testing to child immunization programs as ways to protect the health of both mother and child. Newly introduced testing equipment
could help us make even more progress by significantly reducing the amount of time it takes to get TB test results back, and increasing the accuracy of those results – while also detecting more dangerous drug-resistant TB.
The Foundation’s International Leadership Award – supported in 2007 by Jewelers For Children
– has funded much of Dr. Hesseling’s research, which has already been published in several major medical journals. Her work has also quickly led to changes in clinical practices, such as better tracking of potential TB cases in children in South African clinics, and revised WHO policy about when to best vaccinate HIV-exposed infants for TB.
She has mentored several younger researchers through her award, and is helping build capacity for clinical research that can be quickly translated into practice, something that is urgently needed in South Africa.
Dr. Hesseling made clear that like HIV, TB is both preventable and treatable in children. But it requires vigilance and quick interventions to keep children from falling through the cracks, and to ultimately save lives.
Dr. Anneke C. Hesseling - World TB Day from EGPAF on Vimeo.
Jen Pollakusky is a Senior Public Policy and Advocacy Officer for Africa, based in Washington, D.C