FEWER than half of tuberculosis (TB) patients in Latin America and the Caribbean are currently tested for HIV, and people living with HIV are not always screened for TB even if they show symptoms of the disease.

As a result, most people in Latin America and the Caribbean who are coinfected with both HIV and TB do not know it and are not receiving treatments that could cure or reduce illnesses and prevent deaths from both diseases.

Public health experts say the problem stems from insufficient coordination between programmes aimed at HIV/AIDS patients and programmes for TB patients.

Against this background, the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO) have organised two meetings in Panama city over today to Friday in Panama City aimed at promoting stepped-up coordination among these programmes and with other public health partners, particularly in civil society.

The meeting will involve the heads of HIV and TB programmes from 18 Latin American and Caribbean Countries and experts from the UNAIDS, United States Agency for International Development, the US Centers for Disease Control and Prevention, the Pan American Association of Infectology, United Nations Office on Drug and Crime, and the International Labour Organisation (ILO), among others.

In addition, UNAIDS will host a workshop on 'Accelerating Advocacy on TB/HIV' today for representatives of patient advocacy groups and other civil society organisations from 15 countries in the region.

The impact of TB/HIV coinfection is worrisome. Worldwide, TB accounts for nearly one in four deaths among people with HIV, according to WHO estimates. People with HIV infection are 20 to 30 times more likely to develop active TB disease than people without HIV.

Moreover, people with HIV are at risk of infections with drug-resistant TB, which does not respond to first-line antibiotics, as well as extensively resistant TB, which resists both first- and second-line anti-TB drugs. In these cases, mortality is extremely high.

The best way to address these problems, experts say, is through increased collaboration between healthcare providers and TB and HIV programmes and through joint monitoring and surveillance of the two diseases.

"There are excellent examples of coordination between TB and HIV programmes in Latin America and the Caribbean that have produced better prevention and treatment of the TB/HIV coinfection," said PAHO Director Dr Mirta Roses. "We need to multiply these examples across our region. We're asking ministries of health to step up coordination between their TB and HIV programmes, using an integrated approach to prevent these diseases and to better help those who suffer from them."

In the PAHO/WHO meetings, experts will present recommendations on scaling up collaborative activities between HIV and TB programmes such as:

* Surveillance of HIV prevalence among TB patients;

* Intensified TB case-finding among HIV patients;

* Better TB infection control in health care and congregate settings;

* HIV testing and counseling for TB patients;

* Promotion of HIV prevention among TB patients;

* Use of preventive therapies for TB in HIV patients;

* Use of recommended antiretrovirals for TB/HIV patients; and

* Joint planning, monitoring and evaluation of TB and HIV programmes

To support efforts to intensify HIV-TB collaboration, the experts will urge the active involvement of public and private health care providers, partner organisations, patients and patient advocates, and other members of the community and civil society.

"We're calling on governments, health providers, academic institutions, and members of civil society to support these efforts," said Dr Roses. "HIV and TB are both preventable. For people who are already infected, HIV is treatable and TB is curable. With the proper coordination, we can do a lot to improve the lives of all these patients."