Tropical Health Matters

Last year EM Kamau wrote about “the enormous potential that exists between (the HIV and the Malaria) initiatives that seek to address closely related issues and targeting the same populations at risk within a fairly well defined geographical setting”  in the African Journal of Health Sciences. These synergies are not always found in practice. The HIV/AIDS project of the Nigerian NGO Mothers’ Welfare Group targets orphans and/or children affected by HIV. They provide specialized VCT for children and young adolescents and medical care for opportunistic diseases such as malaria. Even though they are working in Kaduna State, which receives support from the Nigeria’s Global Fund Malaria grant, they have found difficulty in obtaining ACTs and ITNs for the vulnerable and HIV-infected children in their care.

The US President’s HIV/AIDS program, PEPFAR, does talk about the need to provide malaria services for people affected by HIV. “PEPFAR-supported interventions to optimize survival of HIV-exposed and -infected children include provision of basic preventive care, including support for infant and young child nutrition, immunizations and prevention of infections such as malaria, tuberculosis, and pneumonia. The pediatric preventive care package includes life-saving interventions, such as cotrimoxazole prophylaxis to prevent opportunistic infections, including diarrheal disease; screening for tuberculosis and malaria; prevention of malaria using long-lasting insecticide-treated mosquito nets; and support for nutrition and safe water.” Under PEPFAR pallitive care shoud include “Provision of the following drugs and commodities: cotrimoxazole; isoniazid; insecticide-treated bed nets; point-of-use water treatment and safe-water storage vessels; soap; and hand – washing instructions for HIV-exposed and -infected children.” PEPFAR even sets reportable indicators around malaria: “PEPFAR indicators for palative care include: Number of service outlets/programs providing malaria care and/or referral for HIVinfected clients (diagnosed or presumed) as part of general HIV-related palliative care. This number is a subset of the number of service outlets/programs providing general HIV-related palliative care.”

Conversely, the US President’s Malaria Initiative acknowledges the need to target PLWHAs as a vulnerable group in malaria prevention and control. As seen in the PMI country action plan for Uganda, “This will be achieved by reaching 85% coverage of the most vulnerable groups-children under five years of age, pregnant women, and people living with HIV/AIDS-with proven preventive and therapeutic interventions, including artemisinin-based combination therapies (ACTs), insecticide-treated nets (ITNs), intermittent preventive treatment (IPT) of pregnant women, and indoor residual spraying (IRS).”

PEPFAR and PMI program planners are consciously thinking about the synergistic possibilities in addressing malaria in HIV.  Other donor efforts and national disease control programs should collaborate more on these two crucial health problems.

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