Guinea: research for improving the standards of screening and treating tuberculosis in people with HIV
Tuberculosis is one of the main causes of death in people with HIV. The immune system in HIV+ people is severely weakened and diagnosing TB can be more difficult because the disease often manifests in different ways. This is why the Community of Sant’Egidio’s DREAM programme, in collaboration with the University of Tor Vergata, suggested carrying out research to provide data on the prevalence of tuberculosis in people with HIV and the introduction into clinical practice of the most advanced standards recommended by the WHO for the diagnosis of TB in HIV+ patients. This research is part of the “Enhancing the response to the HIV epidemic in Guinea” project, selected by the Italian Agency for Development Cooperation from the proposals for the Technical Support Spending Call in the Global Fund for the Fight against AIDS, Tuberculosis and Malaria.
In order to carry out this research, the Community of Sant’Egidio purchased a device, the Genexpert, which is considered by the WHO to be particularly effective for the rapid diagnosis of tuberculosis in patients with HIV. The diagnostic equipment is at the Conakry healthcare centre and will make it possible for patients to have a much more effective molecular biology test than the ones used currently in Guinea, because it can identify the disease in a short time, even in the presence of only a very few bacilli. This method, together with the LAM urine test, will make it easier to acquire fundamental data for improving the quality of the healthcare and reduce mortality in people with HIV.
In order for this new diagnostic tool to be used properly, training courses will be provided for 4 laboratory technicians to teach them all the skills necessary for the screening phase and for recording the results.
The research will involve about 1,000 adult HIV patients who are being treated in the 4 DREAM healthcare centres in Guinea. The people who give their consent to take part in the study will first undergo a Genexpert test and then a LAM test (on sputum and urine respectively). Once the results arrive, the patients who test positive and therefore have TB, will be referred to the tuberculosis treatment centre closest to where they live and will be monitored and supported by a community worker of the DREAM programme in order to make sure they adhere to the treatment.
In addition to bringing concrete benefits to the patients involved, the research will also have a positive impact on the entire population. The data collected will in fact be presented to the scientific community in specialised articles and conferences and will also be made available to the local authorities, who will then be able to implement specific health policies for diagnosing TB in HIV+ people.