What Works for Women and Girls

Promising Strategies:2. Screening for TB during routine antenatal care in high HIV prevalent settings results inincreased TB detection rates in women and is acceptable to most women, though stigmamay be a barrier.Pregnant HIV-positive women who have active TB are at higher risk for mortality. “Thereis a strong evidence base for screening pregnant HIV-infected women for TB as partof antenatal care. Intensified case finding for TB can reduce morbidity and mortalityand prevent transmission of TB in families, the community, and health care settings.Delaying the diagnosis of active TB significantly increases the proportion of infectedcontacts” (DeLuca et al., 2009: 197). “Although there is a wealth of evidence suggestingthat screening for active TB during routine antenatal care would be a beneficial intervention,especially in places with efficient PMTCT program, no country programs haveimplemented this strategy as part of best practices” (DeLuca et al., 2009: 198). (Gray III)(TB, screening, antenatal care)At two PMTCT program clinics in Soweto, South Africa, 370 HIV-positive pregnantwomen were screened for TB symptoms by lay counselors during post-test counselingsessions. Eight women were found to have previously undiagnosed, smear-negative TBdisease. Active screening for TB symptoms is feasible. (Kali et al., 2006). (Gray IV)(PMTCT, TB, South Africa)Clients accessing antenatal clients, TB patients, and medical providers from five healthfacilities in Kasungu District, Malawi were interviewed to assess the acceptability of TBscreening and TB treatment. Most clients found screening acceptable but expressedconcern about HIV stigma. All of the service providers agreed that TB screening wasimportant but expressed concern about the increased workload (Sangala et al., 2006).(Gray IV) (TB, screening, treatment, stigma, Malawi)3. Infection control of TB within health care settings can reduce the incidence of TB amonghealth care workers, particularly nurses. [See Chapter 13. Structuring Health Services to MeetWomen’s Needs]Gaps in Programming—Tuberculosis1. Efforts are needed to reduce TB-related stigma for women.2. A combination of infection control strategies may significantly reduce the rate of TBtransmission, including drug-resistant TB, in high-risk, low-resourced health caresettings.276 CHAPTER 10 PREVENTING, DETECTING AND TREATING CRITICAL CO-INFECTIONS