Table 1 Specific interventions to address HIV and tuberculosis grouped under the main stratagems for epidemic control
Stratagem | HIV | Tuberculosis |
|---|---|---|
Prevention of primary infection | ||
behavioural modification | decreased risk exposure, e.g. safe sex and decreased sex partners [25] and safe injecting drug use [26] | education, e.g. cough hygiene [27] |
environmental modification | decreased risk of occupational exposure through safe handling and disposal of sharps | environmental measures to decrease nosocomial transmission [27, 28] (particularly important where HIV prevalence is high) |
protect site of infection | vaginal microbicides (under evaluation) [29] | face masks (NN95 specification) [27] |
Modification of risk factors for infection | ||
promote decreased substance abuse | ||
detect and treat conditions associated with increased risk | treatment of sexually transmitted infections [33] | detection and management of diabetes [34] |
modify personal biological characteristic | male circumcision [35] | Â |
Drug prophylaxis | ||
pre-exposure | pre-exposure prophylaxis (under evaluation) [36] | isoniazid preventive treatment for infants born to mothers with tuberculosis [37] |
pre- and post-exposure | prevention of mother to child transmission [38] | Â |
post-exposure | post-exposure prophylaxis [39] | isoniazid preventive treatment for people with latent M. tuberculosis infection or for people at high risk of recurrent tuberculosis [40] |
Decreased transmission by treatment of infected individuals (treatment as prevention) [41] | ||
| Â | prompt diagnosis and effective treatment of people with symptomatic HIV-related disease [42] | prompt diagnosis and effective treatment of people with symptomatic pulmonary disease [23] |
| Â | proposal for prompt diagnosis among asymptomatic individuals either through an individual seeking a test for HIV after an at-risk exposure or through regular universal testing [43] | efforts aimed at decreasing diagnostic delay through community education, improved access to care, and improved quality of clinical care [44] |
Vaccination to prevent progression from infection to disease | ||
| Â | no vaccine yet available | Bacille Calmette-Guerin (BCG) vaccination [45] |