TB in Populations At Risk for HIV, Mexico

Image source: http://en.wikipedia.org/wiki/File:TB_in_sputum.png

Article: http://www.cdc.gov/eid/content/16/5/pdfs/757.pdf

In order to determine the rate of latent TB infection in Tijuana, Mexico (where there is both little routine TB screening and a rising epidemic of HIV infection) the University of California at San Diego School of Medicine and San Diego County Department of Health and Human Services alongside several universities and government agencies in Tijuana, Mexico conducted a study to examine latent TB in marginalized populations. They recruited from three at-risk populations for HIV-- injection drug users, female sex workers, and homeless persons-- and conducted risk assessment, rapid HIV testing, and TB screening.

The authors found that 57% of eligible recruits were positive for TB infection, 4.2% were HIV positive, and 2.2% were positive for both TB infection and HIV. 2 participants were diagnosed with active TB. From this data, the authors found that TB was exceptionally high in these marginalized populations (at risk for HIV infection), though actual HIV rates in these populations were lower than originally estimated. However, despite finding lower rates of HIV infection that expected, the rate of HIV infection in Tijuana is still higher than the rest of Baja California. From this data, the authors claim that if there is an increase in HIV infection in these populations that already show high rates of TB infection, the reactivation and spread of TB (due to compromised immunity) will increase more rapidly than TB control efforts will be able to contain.

This study shows that there is indeed a strong relationship between TB infection and risk factors for HIV infection. However, it seems as though these two epidemics are treated independently of one another in both prevention and treatment efforts. Both HIV and TB screening is insufficient in this region, though there is obvious room for overlap and coordination in conducting both screens simultaneously since they share common risk groups. Do you think there should be better coordination in screening and treatment across different diseases and infections, or should one singular disease that is deemed most critical (in this case, HIV) be the primary focus ?