One-fourth of the world's population is infected with tuberculosis (TB) and it is the leading killer of people with HIV. For World Health Day, Kartlos Kankadze shares best practices for combating TB and HIV co-infection.

Dr. Kartlos Kankadze is the director of the Human Resources for Health in 2030 program’s Philippines buy-in and previously served as the chief of party of the USAID Strengthening Tuberculosis Control in Ukraine project.

What is TB/HIV co-infection, and why is it such a serious issue?

Tuberculosis is a curable and preventable infectious disease caused by bacteria that most often affects the lungs. HIV-positive people are more susceptible to infections than anyone else — and more vulnerable to tuberculosis (TB) in particular. Clinically, people infected with HIV experience more severe forms of TB than patients without HIV because their immune systems are already compromised, so the disease advances faster and more intensely. And mortality is higher if TB is not treated on time, or not treated with the proper regimen for TB/HIV co-infection. TB is transmitted by inhaling droplets that leave an infected person’s mouth. When we consider TB transmission, special attention should be paid to people who are HIV positive —  they are both susceptible to contracting the disease and have the least immune defenses to fight it.

Co-infection is especially terrible when TB is multi-drug resistant, which refers to a strain of TB that does not respond to the two most common antibiotics used to treat TB. These TB bacteria are very aggressive and difficult to treat in any person — and especially in immunocompromised HIV patients. It is imperative to address multi-drug resistant TB, as it poses a threat to progress made against TB and HIV alike.

What lessons has Ukraine learned from addressing TB/HIV co-infection that you hope to see replicated in other countries?

In Ukraine, we developed guidelines to improve the way TB is detected and treated. Before, the common practice was to send people with HIV to TB hospitals. In essence, we were sending immunocompromised people to places with very weak infection control and multiple cases of active TB — leaving them even more exposed to contracting a TB infection.

Now, in the one-stop shop model, TB and HIV treatment can be initiated at the primary health-care level. We can collect sputum to diagnose TB and integrate HIV services all at the primary health-care level and without going to a TB hospital. This integrated model is the WHO recommendation for TB treatment and care and we are proud to have implemented it in Ukraine.

You began your career as a pediatrician and general practitioner. How does your experience with clinical-level health service delivery influence your approach to addressing TB?  From your previous experience as a health worker, what role do health workers around the world play in combating the disease?

Both TB and HIV are peculiar in that the best prevention of the diseases is treatment of them. The best reservoir for TB is existing patients, so health workers become especially important for providing screening and treatment to reduce the number of active TB cases and minimize the disease’s spread. The same goes for HIV — when you treat HIV, a patient’s viral load decreases and so does the risk of transmission.

Our project worked to train clinicians and health-care workers to address the TB epidemic in Ukraine by increasing knowledge and tools around infection control and diagnosis of TB and integrating TB and HIV services at the primary health-care level. It is important to marry knowledge and experience in diagnostic methods, microbiology, and infectious disease work with public health practice and management. In tandem, these three pieces are key to reducing the impact of both diseases. Through our work at Chemonics and with our partners around the world, we have been able to move the needle on TB/HIV co-infection in Ukraine and we are excited to continue to share our best practices with partners around the world.