Disease in the News

The article Tuberculosis in Africa- Combating an HIV-Drive Crisis is written by a Dr. Richard E. Chaisson, a medical doctor and Dr. Neil A. Martinson, deputy director for the Perinatal HIV Research Unit at the University of the Witwatersrand in South Africa (Chaisson and Martinson, 2008 ).

According to the biography sketch of Dr. Chaisson listed at the website of CREATE (Consortium to Respond Effectively to the AIDS TB Epidemic), Dr. Chaisson is a professor of Medicine at the Johns Hopkins University School of Medicine and is currently a director for the Center for Tuberculosis Research and the Clinical Preventive TB Services in Baltimore City Health Department (Consortium to Respond Effectively to the AIDS TB Epidemic 2008). He graduated summa cum laude from the University of Massachusetts and studied medicine from the University of Massachusetts Medical School in 1982 (2008). From then on, Chaisson interned at the University of California, interning at the Moffitt Hospital. (2008).

Previous to his current position at Johns Hopkins, Dr. Chaisson was the director for the AIDS Service of Johns Hopkins Hospital (2008). He also served as attending physician in the AIDS Division of The Medical Service in San Francisco General Hospital (2008). Likewise, he has written more than 50 case reports, peer and non-peer reviewed articles on topics concerning HIV and tuberculosis (2008). Needless to say, his educational and professional background [in tuberculosis and AIDS] make him a credible source for this article which focuses on tuberculosis and AIDS.

On the other hand, Neil Martinson, as stated earlier, is a deputy director for the Perinatal HIV Research Unit at a university in South Africa (Chaisson and Martinson, 2008). Aside from his, Martinson is a Research Associate for the Johns Hopkins School of Medicine, JHU Center for TB Research (Consortium to Respond Effectively to the AIDS TB Epidemic 2008). Martinson’s credential as listed from the CREATE website state that Martinson took up his bachelor’s degree from the University of the Witwatersrand in South Africa, obtained his Membership of the Faculty of General Practitioners (MFGP) in College of Medicine in South Africa (2008).

Furthermore, he completed his post- doctorate studies at the Johns Hopkins University Bloomberg School of Public Health (2008). Prior to his present position, Dr. Martinson served for the Johannesburg Community and the Johannesburg Urban Environmental Management (2008). He has since co-written peer-reviews research articles and non peer-reviewed publications on AIDS, focusing primarily of the South African health status (2008). While Dr. Chaisson’s fortes are tuberculosis and AIDS, Dr. Martinson’s strong points gear towards AIDS and South Africa.

This makes Drs. Chaisson and Martinson credible in writing such article. Tuberculosis in Africa- Combating an HIV-Drive Crisis appeared in the New England Journal of Medicine on its Volume 358 (Chaisson and Martinson 2008). The journal is a weekly medical journal publishing review articles and medical research findings on areas such as “immunology, cardiology, endocrinology, gastroenterology, hematology, kidney disease, oncology, pulmonary disease, rheumatology, HIV and infectious diseases” (New England Journal of Medicine, 2008).

The article tackles the growing tuberculosis outbreak in Africa, a dangerous disease driven yet another perilous epidemic in the nation- AIDS and how it is being dealt with (Chaisson and Martinson, 2008). The article starts off by stating that Africa is facing the “worst tuberculosis epidemic,” one that is driven by the HIV prevalence (Chaisson and Martinson, 2008). The authors cited a World Health Organization (WHO) data affirming the status of tuberculosis incidence in African nations (29% of total global cases) (2008).

It also exclaimed, based on two separate studies, that tuberculosis is the “most common coexisting condition” in deaths occurring in people with AIDS (2008). Said studies were published in 2002. The article was written just this year, in March. While the studies proved to be useful in preparing the article, this reviewer feels that the assertion would have been more forceful had the authors included studies that are up to date. For one, the WHO citation came from a 2007 WHO report. It is without a doubt, an updated report.

The impact is still fresh. The article talks of a prevalent epidemic so it is rather important to have supporting data that are latest. Earlier studies would only serve as basis for comparison. In the article, the authors explained how tuberculosis and HIV are associated (2008). The explanation is simply stated and since this article is intended for a medical journal, this critic thinks that the explanation is written well, no beating around the bush. Instead, the elucidation is done matter of fact.

There is no need for supporting statement or evidence since the article is targeted for those in the field of medicine. Hence, an explanation like this is something that they know of well. They probably memorize it. Since the disease is focusing only on Africa, the authors are able to provide a national perspective on the epidemic. Figures culled from Africa-related studies are enumerated, making it plain for the readers to realize that that this article is about Africa related incident alone.

The focus is Africa so the authors did not include statistics from other countries. This provides a clear focus on the subject. The authors also explained how the nation is dealing with the epidemic. They said that while NGOs have helped tremendously in solving Africa’s health plague, a huge chunk of the money is allocated from HIV and not for tuberculosis. There is no supporting evidence to back this statement. Hence, this reviewer believes that this bold statement would have made more impact had the authors gave further corroboration.

However, this critic also believes that this would have been difficult to make. Funding agencies would probably just state that they are donating money to help Africa solve its health problems and that would encompass HIV, tuberculosis, etc. A donation is still a donation and any help extended should be received with gratitude. Perhaps, it would have been easy if further studies regarding HIV-driven tuberculosis deaths are published. By then, prospective donors would be the first to extend their arms in funding.

The authors enumerated ways on how Africa could deal with this dilemma – taking on new strategies regarding its health care system. They also cited WHO’s intervention. Additionally, they listed a study conducted in 2005 on the impact of antiretroviral therapy involving HIV infected patients in Brazil. This is promising, especially for those directly involved with the African health care system. It is good that the authors included this recent development for it would be something that Africa could look into.

On the whole, the article is well-written. It is easy to read. The organization of data is presented in a way that the readers, technical or non-technical, would be able to follow it. Furthermore, the authors are two authorities in their respective fields and that alone makes them credible in writing such piece. The statements (majority) are backed with supporting evidence. They did not claim on how to eradicate the outbreak. They merely provided suggestions, again with evidence, on how it could be done.