In sub-Saharan Africa, tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV), and parental deaths due to TB have resulted in almost 10 million orphan children worldwide by 2009. As the number of women living with HIV has increased, TB incidence among women in their childbearing years has also increased, leading to an increased risk of TB- and HIV-related morbidity and mortality for mothers and their children. In high HIV prevalence settings, such as sub-Saharan Africa, TB is reported to cause up to 15% of all maternal mortality. Maternal TB presents a risk not only to the pregnant woman, but also to her newborn and young children. HIV-infected pregnant women with TB disease are at increased risk of transmitting both TB and HIV to their infants. Focusing efforts on prevention, identification, and treatment of TB disease in HIV-infected pregnant women has the potential to improve health outcomes not just for women, but for their children as well.
Purpose and Intended Use of the Tool
In countries implementing lifelong antiretroviral treatment (ART) for pregnant and breastfeeding women (commonly referred to as “Option B+”), prevention of mother-to-child HIV transmission (PMTCT) sites will effectively function as HIV care and treatment centers for women and, often, for their children and families as well. As national PMTCT programs are revising guidelines, training curricula, and recording and reporting tools for Option B+, this is a unique opportunity to incorporate TB/HIV activities into program planning efforts. TB/HIV services should also be integrated into the broader continuum of maternal, newborn, and child (MNCH) settings, including community and facility-based sites providing postpartum services, immunizations, and other child health interventions. In order to reduce the impact of TB among mothers and children, it is essential that PMTCT and MNCH programs adopt the World Health Organization (WHO) recommendations for TB/HIV, including implementing TB intensified case finding (e.g. screening of all PLHIV and systematic evaluation of contacts of people with potentially infectious TB), infection control measures, and isoniazid preventive therapy (IPT).
This checklist is intended to assist national program managers, clinic administrators, and other public health officials as they work towards integration of TB/HIV services in PMTCT and MNCH programs.