India: Why TB, HIV control programs may not be combined

Last month, Union Health Secretary Preeti Sudan chaired a meeting attended by senior officials from the National Health Mission (NHM), National AIDS Control Organisation (NACO), and Health Secretaries of Gujarat, Bihar, and Tamil Nadu. The move to combine the programmes was discussed, and it was opposed by most quarters.

NACO had requested an explanation on how the two vertical programmes will be merged, following Prime Minister Narendra Modi’s speech that the TB team should take lessons from the implementation of the HIV programme.

Feasibility report

An expert committee formed to study the feasibility of the merger has also submitted its report to the Health Ministry.

NHM officials and the State Health Secretaries objected to the merger of the two programmes. “Multiple problems will emerge on the ground if HIV and TB interventions are merged,” said an official who had attended the closed-door meeting.

The official said that Tamil Nadu’s Health Secretary, Darez Ahmed, said the ground-level integration of HIV and TB patients is risky. “HIV patients have low immunity. If they come in close contact with TB patients, they are at a larger risk to catch the TB bacteria,” Ahmed said.

The funding structures for the Revised National Tuberculosis Programme (RNTCP) and the National AIDS Control Programme (NACP) are different. While the RNTCP is funded by both the Centre and the States, the NACP is fully funded by the Centre.

“The contribution of States’ Health Departments for eliminating TB is extremely crucial. If the States are not interested, the elimination will be hard to achieve,” said another official who attended the meeting.

They also argued that while HIV is restricted to a limited population which falls under high-risk categories, TB can infect anyone as it is transmitted through air.

“The modes of transmission of HIV and TB are different. The ordeals that the patients suffer are different. While the TB team should learn from the HIV personnel on how to mobilise patients, merger of the two programmes is not advisable,” said the official.

Prevalence

In India, the number of HIV patients is estimated at 21.17 lakh with 80,000 new HIV patients and 62,000 AIDS related deaths in 2016.

India's TB burden is 28 times more than HIV.

The decision to merge the two programmes now rests with the Union Health Ministry.

Source: The Hindu BusinessLine