Feature story

Need for scale up in integrated TB and HIV screening to address linked epidemics

24 March 2009

Although it is mostly preventable and curable, tuberculosis (TB) is one of the leading causes of death among people living with HIV globally. Of the 33 million people who are living with HIV, only 20% of know their status, and only a tiny fraction, 2% in 2007, were screened for TB according to the World Health Organization’s annual report on global TB control launched today.

HIV is dramatically fuelling the TB epidemic in sub-Saharan Africa, where up to 80% of TB patients are co-infected with HIV according to the report. A respiratory infection that spreads like the common cold, TB exploits an immune system already weakened by HIV.

“We have to stop people living with HIV from dying of tuberculosis,” said Mr Michel Sidibe, Executive Director of UNAIDS. “Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives.”

"We have to stop people living with HIV from dying of tuberculosis. Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives."

Mr Michel Sidibe, Executive Director of UNAIDS

Global Tuberculosis Control 2009 provides an up-to-date assessment of the TB epidemic and progress in controlling the disease. It notes that globally only 16% of TB patients know their HIV status and so the majority of HIV-positive TB patients do not know that they are living with HIV and are not accessing HIV treatment.

However, there has been progress in this area with increased HIV testing among people being treated for TB, especially in Africa. In 2004, just 4% of TB patients in the region were tested for HIV; in 2007 that number rose to 37%, and in some countries (Kenya, Lesotho, Malawi, Rwanda and Swaziland) over 70% of all TB patients know their HIV status.

Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need. In 2007, 200 000 HIV-positive TB patients were enrolled on co-trimoxazole treatment to prevent opportunistic infections and 100 000 were on antiretroviral therapy.

Need for integrated TB and HIV services

For many years efforts to tackle TB and HIV have been largely separate, despite the overlapping epidemiology. Improved collaboration between TB and HIV programmes will lead to more effective prevention and treatment of TB among people living with HIV and to significant public health gains.

The release of the report today coincides with World TB Day and a 1500-strong gathering at the 3rd Stop TB Partners’ Forum in Rio.

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