A Reader Responds to "Tuberculosis and HIV--Needed: A New Paradigm for the Control and Management of Linked Epidemics"

Chinwe Owunna, BPharm, MPH


December 11, 2007

To the Editor,

I am writing in reference to the recent article on linking the control and treatment of tuberculosis (TB) and HIV in developing countries.[1] Although the World Health Organization has provided several guidance documents and technical assistance to countries to establish policies and promote TB/HIV collaboration,[2] countries are finding it challenging to translate polices into action at the operational level. In addition to the issues that Tsiouris and colleagues[1] describe, another important area in controlling TB/HIV coinfection is ensuring the uninterrupted availability and rational use of pharmaceuticals required for diagnosis, prevention, and treatment of coinfected patients. Programs that do not plan for the management of pharmaceuticals and supplies needed for TB/HIV collaboration suffer from stock-outs that affect overall program goals as well as patients' well-being.

Our study in Ethiopia, Kenya, Malawi, Tanzania, and Uganda to investigate the management of pharmaceuticals required for TB/HIV collaboration activities[3] found that the strategy for managing pharmaceuticals was often decided on the basis of a historical supply of particular medicines (for example, isoniazid by the TB program), or by the sources of funding available (for example, cotrimoxazole being procured with HIV/AIDS donor resources). However, having one public health program, such as the TB or HIV/AIDS program, responsible for managing a specific product for collaborative activities often results in stock-outs of pharmaceuticals and supplies because of lack of coordination and poor management; for example, multiple programs use HIV rapid test kits, but because they do not regularly share information related to product consumption, the numbers of test kits needed are often underestimated and patients have to be turned away. Insufficient funding or confusion about which funding source is responsible for TB/HIV collaborative activities also plays an important role in stock-outs. Additional challenges include a limited number of skilled pharmaceutical staff, who are often left out of the planning and implementation process, and inadequate monitoring, evaluation, and supervision of new collaborative activities.

Many opportunities do exist to improve the management of TB/HIV pharmaceuticals and services in public health programs; for example, by:

  • Including pharmaceutical staff in the planning and management of TB/HIV activities, including training; and

  • Developing a long-term strategy for strengthening the pharmaceutical management information system, including sharing data across programs and integrating information systems where possible.

A summary of the 5-country study results with lessons learned and recommendations for including management of pharmaceuticals in TB/HIV collaborative activities is available at


Chinwe Owunna, BPharm, MPH
Senior Program Associate
Rational Pharmaceutical Management Plus Program
Management Sciences for Health
Arlington, Virginia

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