Addressing poverty key to better TB and HIV treatment in Uganda

Faculty; Global; Research

Experts from the Brown School at Washington University in St. Louis are calling on HIV and tuberculosis researchers in Uganda to focus on combating poverty as a key strategy to improve treatment outcomes for those co-infected with HIV and tuberculosis (TB).

In a correspondence published in the August 31 issue of The Lancet, the authors highlight that poverty—a key social determinant of health—drives poor treatment outcomes for both HIV and tuberculosis. In Uganda, for example, many health facilities lack TB treatment services, forcing patients to travel long distances at high costs to access care.

“Tuberculosis is the leading cause of death among people living with HIV and, despite being curable, is responsible for over one-third of all HIV-related deaths worldwide.1 Uganda is one of the 30 high-burden tuberculosis–HIV countries in the world, with an annual tuberculosis incidence ranging between 200 and 350 cases per 100 000 people. Moreover, with a tuberculosis–HIV co-infection rate of 40%, HIV is the biggest driver of tuberculosis,” they wrote in the correspondence. 

In high-burden countries like Uganda, up to half of all TB patients fail to complete their treatment. This non-completion leads to ongoing infectivity, drug resistance, disease relapse, and preventable deaths, with the treatment success rate for TB-HIV co-infected patients remaining at just 70%. Economic factors exacerbate the issue, with over half of TB patients’ households in Uganda facing catastrophic expenses, spending 20 to 40% of their income on TB care. Costs average $369 per episode for drug-sensitive TB, with higher expenses for those co-infected with HIV.

“Unfortunately, poverty has not been prioritised in HIV and tuberculosis research, with very few studies testing interventions that target household poverty in patients with HIV and tuberculosis,” the authors wrote. “ 

The correspondence was led by Samuel Kizito, a research assistant professor at the Brown School. Additional authors include Josephine Nabayinda, research associate at the International Center for Child Health and Development (ICHAD); Proscovia Nabunya, an assistant professor; and Fred Ssewamala, the William E. Gordon Distinguished Professor — all from the Brown School.