In 2017, 300,000 of the total 940,000 global HIV deaths occurred among people infected by both HIV and tuberculosis (TB), according to the WHO "Global TB report 2018" launched last week. To reach the 2020 targets and reduce these preventable and treatable HIV deaths from TB, we must coordinate efforts to jointly address the 2 epidemics, hand-in-hand with communities, within the framework of universal health coverage.
The need for integrated, community-based care for TB and HIV is the focus of a breakfast summit titled "Leave no one behind: scaling up integrated people-centred TB/HIV care towards universal health coverage". The summit will be held this morning, ahead of the United Nations (UN) High-Level Meeting on TB.
The summit brings together political leaders, funders, implementing partners and affected communities to outline pressing challenges, existing gaps and emerging opportunities to end the TB and HIV co-epidemics. Discussions will aim to revitalize shared commitments by stakeholders and translate these commitments into renewed action in countries.
Interested members of the public can join the summit, which will be live-streamed via Facebook (link on the right).
Why Is It a Priority to Address TB in the HIV Response?
People living with HIV are 20 times more likely to become ill with TB than those without HIV. Even when on TB treatment, people coinfected with HIV and TB are 3 times more likely to die from TB.
It is estimated that 49% of people with HIV and TB are unaware of their coinfection and are not receiving care. This is due to low rates of testing and diagnosis for both infections at clinics that provide services for the 2 diseases.
Referral and linkages to treatment services are insufficient for people diagnosed with HIV and TB coinfection. It is estimated that only 41% of people with HIV-associated TB are receiving antiretroviral therapy for HIV.
There is a low uptake of TB preventive treatment among people with HIV. Despite WHO's strong recommendations on this topic, only 36% of people with HIV newly enrolled in care across 59 countries were accessing TB preventive therapy in 2017.
It is highly concerning that children are overlooked in the TB response -- it is estimated that over half of children living with TB remain undiagnosed including children who may be coinfected with HIV .
Finally, people with HIV and TB experience stigma and discrimination, preventing them from seeking care for both diseases -- thus delaying diagnosis and treatment. Other challenges in addressing these co-epidemics include social factors such as poverty, poor housing conditions, malnutrition, lack of education, and harmful environmental conditions in settings such as prisons and mines.
What Are the Solutions?
At the UN High-Level Meeting on TB, global leaders will discuss how better-integrated policies and investments can change the course of the TB and HIV epidemics. Attaining the global Sustainable Development Goal targets to end TB and AIDS by 2030 will require all stakeholders to jointly implement integrated, community-based responses to close the gaps in prevention, diagnosis and treatment of TB/HIV infections, and ensure universal access to care, leaving no one behind.
The keys to achieving this are better-coordinated planning and well-funded, quality care and prevention for HIV-associated TB. This means we need to improve data systems, diagnostics, laboratories and drug supply, and provide better linkages with other services (e.g. reproductive, maternal, neonatal and child health and harm reduction services), using integrated service delivery models such as "one-stop shops".
Policy solutions exist, including WHO's recommendations to treat all people with HIV with antiretroviral therapy, to focus on the most marginalized and sick people with advanced HIV disease, and to deliver TB preventive treatment. But large-scale implementation of these policies is urgently needed to reduce the number of TB cases among people with HIV and save lives.
All this calls for much closer collaboration between TB and HIV policy-makers to maximize synergies across the different health system components, including laboratories, human resources, health information, procurement and financing, and civil society engagement.
The historic UN High-Level Meeting on TB provides the momentum and political commitment to make these policies reality and put a stop to TB: the single biggest threat to the lives and livelihoods of millions of people living with HIV.
[Note from TheBodyPRO: This article was originally published by the World Health Organization on Sept. 26, 2018. We have cross-posted it with their permission.]