Tuberculosis TB

Ministries of Health from eastern Europe and central Asia adopted on 3 November in Minsk, Belarus, a consensus statement on HIV and tuberculosis (TB) treatment for all, calling for expanded and rapidly scaled-up access to affordable, quality-assured medicines.

Representatives of Ministries of Health of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan endorsed the statement at the conclusion of a two-day regional consultation.

Governments committed to strengthen regional cooperation in order to advance access to affordable and quality medicines and deliver more cost-effective, equitable and sustainable solutions for common challenges by intensifying efforts through regional solidarity, shared responsibility and political leadership.

The statement underlines that countries are ready to use all available tools to reduce the price of life-saving medicines, address intellectual property issues and their alignment with national legislation, support the local manufacturing of medicines and optimize medicine regimens in line with World Health Organization (WHO) recommendations.

More than 160 participants, including representatives of ministries of health, national experts, representatives of the pharmaceutical industry and partners from international organizations and civil society, participated in the regional consultation.

Eastern Europe and central Asia is home to the fastest growing HIV epidemic and the highest levels of multidrug-resistant TB in the world. Expanding antiretroviral therapy eligibility based on the WHO recommendations to treat people who test positive for HIV as soon as possible is expected to have significant cost implications for the HIV response in all countries of the region.

The event was hosted by the Ministry of Health of Belarus with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS and the Stop TB Partnership.

In the 2016 report on the state of the global tuberculosis (TB) epidemic and response, the World Health Organization announced that there were an estimated 10.4 million new TB cases in 2015, higher than previous estimates. However, only 6.1 million TB cases were detected and officially reported in 2015, demonstrating a major gap in finding and testing people who may have TB. Six countries accounted for 60% of the total global burden of TB—China, India, Indonesia, Nigeria, Pakistan and South Africa. Tuberculosis remains a leading cause of death among people living with HIV, despite being curable at low cost. The cost of not treating TB, however, is high in terms of disease spread and death.

In 2015, an estimated 1.8 million people died from TB—of these deaths, 0.4 million occurred among people who were also HIV-positive. More than 20% of people living with HIV and TB disease were not receiving life-saving antiretroviral medicines, a missed opportunity to deliver comprehensive and integrated care and treatment. TB can also be prevented among people living with HIV with early antiretroviral treatment and isoniazid preventive therapy, but uptake of preventive therapy remains inadequate.

A particularly worrying finding from the report is the inadequate response to the rising burden of multi-drug resistant (MDR) TB. Only one in five people who are eligible received treatment for MDR TB in 2015. Furthermore, the cure rate for MDR TB remains disappointingly low, at 52% globally, despite recent improvements in access to new treatments.

Increasing drug resistance is one of the greatest threats to reducing the burden of illness and deaths from infectious diseases, such as HIV, TB and malaria, that prevent many people living in low- and middle-income countries from achieving their full potential. Urgent action is needed to prevent the development and spread of drug resistance, and investment in research to find new therapies to replace those rendered ineffective through drug resistance is critical.

UNAIDS and the Stop TB Partnership have hosted an interactive discussion in New York, United States of America, with representatives of civil society organizations and other stakeholders involved in the response to HIV and tuberculosis (TB). The discussion took place during the Informal Interactive Civil Society Hearing held by the President of the United Nations General Assembly in preparation for the United Nations General Assembly High-Level Meeting on Ending Aids, which will take place in New York from 8 to 10 June. 

During the discussion, the participants described the challenges posed by the epidemics and explored ideas to better integrate the responses. UNAIDS and the Stop TB Partnership have both set ambitious five-year targets to respond to the epidemics and to set the world on course to end them as part of the Sustainable Development Goals.

The UNAIDS 2016–2021 Strategy has established a set of three people-centred goals and 10 measurable targets that must be met by 2020 to end the AIDS epidemic by 2030, including achieving the 90–90–90 treatment target for 2020, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment have suppressed viral loads. Other targets include reducing new HIV infections to fewer than 500 000 per year by 2020 and achieving zero HIV-related discrimination.

The Global Plan to End TB is the Stop TB Partnership’s five-year plan to accelerate the response to TB, and includes a projected investment scale-up from 2016 to 2020 to reach a 90–(90)–90 target. This includes reaching at least 90% of all people diagnosed with TB and enabling them to have access to appropriate therapy as required, reaching at least 90% of key populations living with tuberculosis and achieving 90% treatment success for all people diagnosed with tuberculosis.

Prevention of HIV and tuberculosis will also play a key part in ending both epidemics. 

Tuberculosis is a major cause of mortality among people living with HIV and is currently responsible for one in three AIDS-related deaths. 

GENEVA, 24 March 2016—On World Tuberculosis (TB) Day, UNAIDS is calling for stronger partnerships and a united approach to end the twin epidemics of TB and HIV and save millions of lives. It has never been more urgent for governments, the medical and scientific communities, the private sector and people affected by the diseases to come together to ensure access to existing treatment regimens and to push for new diagnostic tools and treatments to reach all people in need.

“We achieve the most when we work together and use all our strengths to reach ambitious goals,” said UNAIDS Executive Director, Michel Sidibé. “Harnessing the potential of everyone involved in the response to HIV and TB is needed now more than ever to end these epidemics and create a healthier world as part of the Sustainable Development Goals.”                

Globally, 9.6 million people fell ill with TB in 2014 and 1.5 million people died of the disease. TB also remains the leading cause of death among people living with HIV, accounting for one in three AIDS-related deaths every year – around 390 000 of 1.2 million AIDS-related deaths in 2014. In addition, around 480 000 people in 2014 developed multidrug-resistant TB. As with HIV, poorer communities and populations affected by stigma and discrimination are most vulnerable to infection.

The international community is committed to ending the epidemics of TB and HIV within the framework of the Sustainable Development Goals. This will be possible only by strengthening and accelerating current responses and by maximizing the contribution of all those involved through a united approach at the international, regional, national and community levels. For example, the development of new diagnostic tools, treatments and potential vaccines against HIV and TB must be speeded up, especially in response to the emergence of multi-drug resistant tuberculosis. Most importantly, these new regimens and tools must be within reach of everyone affected by TB and HIV.

Adopted in 2014, the World Health Organization’s END TB Strategy recognizes that ending the TB epidemic hinges on better policy-making at an international, regional and national level as well as stronger action to increase social protection, reduce poverty and tackle other determinants that increase people’s vulnerability to infection. The strengthening of health-care capacities will also be an important factor in reaching the goals of reducing TB deaths by 95% and new cases of TB by 90% by 2035. The same factors apply to ending the HIV epidemic.

UNAIDS remains committed to working closely together with countries, donors, communities and partners including the World Health Organization, the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria to maximize the full power of communities everywhere to end the epidemics of TB and HIV.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Japan hosted the Fifth Replenishment Preparatory Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) on 16 and 17 December, which laid the groundwork for a pledging conference in mid-2016 at which donors will finalize the Global Fund’s next three-year funding cycle.

The participants included Japan’s Foreign Minister, Fumio Kishida, health ministers from several countries, Margaret Chan, the Director-General of the World Health Organization, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, and Luiz Loures, Deputy Executive Director of UNAIDS.   

”We have an unprecedented opportunity in the next five years to break the AIDS epidemic,” said Mr Loures. “If we scale up care, treatment and prevention services and create an environment where people have full access to them we will be on course to end the AIDS epidemic by 2030.”

On the eve of the meeting, Japan also organized a conference on universal health coverage in order to evaluate the financial systems and funding required by countries to promote access to affordable health care and medicine. Universal health coverage is key to ending the epidemics of HIV, tuberculosis and malaria, which are fuelled by poverty, stigma and discrimination.

Japan has been one of the leading investors in the AIDS response, supporting programmes focused on key populations across Asia and investing in projects such as the Kenya HIV Situation Room, which is using cutting-edge technology to provide high-quality data about that country’s epidemic.

While he was in Japan, Mr Loures also visited PLACE Tokyo, which provides community-based services related to HIV and sexual health, including consultation services for people living with HIV.

“The role of communities remains as critical as ever in addressing the realities, needs and challenges of people living with HIV in Japan,” said Mr Loures. “I congratulate PLACE Tokyo for the work they are doing to support people living with HIV, their partners and family members.”

The Deputy Executive Director of UNAIDS, Luiz Loures, joined a high-level panel in the opening plenary of the 46th Union World Conference on Lung Health to discuss the global challenges faced in ending the linked epidemics of HIV and tuberculosis (TB) as part of the Sustainable Development Goals.

The five-day conference is being held in Cape Town, South Africa, from 2 to 6 December 2015. South Africa has the highest rate of HIV-related TB in the world, with more than 60% of people living with TB in South Africa also living with HIV.  

Mr Loures stressed the need to engage and support the people and communities most affected by TB and HIV. “A people-centred, rights-based approach is essential to address HIV and TB,” said Mr Loures. “The power of change only comes when it is nurtured in the people themselves, through empowerment, outreach and inclusion.”

Constance Manwa, a survivor of multidrug resistant TB, community activist and mother living with HIV said, “Getting the community involved helps a lot. I was a patient but also gave lectures to the other patients in the community. It is important to get the message out to get tested early. People listen more to a person who has the same experience.”

Communities help in tailoring prevention and treatment services to meet the needs of people living with TB and can reach the people who are being left behind. They can also help in providing support for people living with HIV and TB to stay in care and on treatment.

Progress has been made. Since 1990, TB deaths have declined by almost 50%. However, TB is still the leading cause of death in South Africa and a leading cause of death globally. In 2014, more than one million people around the world died of TB. 

“We must stop talking about problems and start talking about solutions,” said Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. ‘We need new drugs, we need new diagnostics, we can definitely eliminate tuberculosis.”

The global tuberculosis (TB) death rate has fallen by almost half since 1990, but more than 4000 people a day are still dying from this preventable disease, says the World Health Organization’s (WHO) Global tuberculosis report 2015, released on 28 October.

TB ranks alongside HIV as a leading cause of death, with 1.5 million people dying from the disease in 2014, 400 000 of whom were HIV-positive. 

There have been notable successes in the TB response and effective diagnosis and treatment have saved 43 million lives in the last 15 years. The TB target of Millennium Development Goal of halting and reversing TB incidence by 2015 was achieved both globally and in 16 of the 22 countries where 80% of cases occur.

According to WHO Director-General Margaret Chan, “The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured.” She added a note of caution, however. “These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research.”

As well as this increased investment, new diagnostics, vaccines and medicines must be developed and funding improved. The report argues that the main cause of gaps in detection and treatment is a significant funding shortfall, which in 2015 amounted to US$ 1.4 billion of the US$ 8 billion needed to implement TB programmes.  

Funding is also critical to finance the ambitious move away from controlling the disease to ending the global TB epidemic, due to begin in 2016. WHO Member States have now adopted the End TB Strategy, which provides a road map for countries to reduce TB incidence by 80% and deaths by 90% by 2030, while also ensuring that families are not crippled by expenses owing to the disease.

“Ending the TB epidemic is now part of the Sustainable Development Goal agenda,” said Eric Goosby, the United Nations Secretary-General’s Special Envoy on Tuberculosis. “If we want to achieve it, we’ll need far more investment—at a level befitting such a global threat. We’ll also need progress on universal health coverage and poverty alleviation. We want the most vulnerable communities worldwide to gain first, not last, in our efforts.”

UNAIDS has welcomed the signing of new grants between Malawi and the Global Fund to Fight AIDS, Tuberculosis and Malaria worth more than US$ 332 million. The agreement brings the total Global Fund commitment to Malawi to US$ 616 million for the period 2014-2017, the highest per capita allocation to any country globally.

The agreement will allow the further expansion of treatment and prevention programmes for all three diseases and build stronger health systems. Community based approaches to HIV prevention and programmes to diagnose new cases of tuberculosis will be scaled up. At the same time as he signed the new agreement with the Global Fund Executive Director, Mark Dybul, the President of Malawi, Peter Mutharika, committed an additional US$ 30 million from domestic resources to bolster the country’s health system.

Malawi has 1.1 million people living with HIV. It has increased the number of people accessing antiretroviral medicines from a few thousand in 2003 to more than 536 000 at the end of 2014.

Health investments made through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnership have saved 17 million lives, according to the Global Fund results report 2015, released on 21 September.

The report shows that the Global Fund partnership has made remarkable gains against HIV, tuberculosis and malaria and provides a broad overview of the results achieved to date.

The results show that programmes supported by the Global Fund have ensured access to HIV treatment for 8.1 million people, a 22% increase since the previous year, and the number of tuberculosis cases detected and treated increased by 11%, to reach 13.2 million. For malaria, the partnership distributed 548 million mosquito nets to protect children and families from the disease, an annual increase of 32%.

According to the report, scientific advances, innovative solutions and increased global support are saving lives at a steadily increasing rate each year—more than two million—putting the partnership on track to save 22 million lives by the end of 2016.

The Global Fund combines the strength of governments, civil society, the private sector and people affected by HIV, TB and malaria. The Global Fund is also strengthening its collaboration with key partners, such as UNAIDS, to build stronger country ownership of programmes that address the rights of people most affected by the diseases.

GENEVA, 24 March 2015—On World Tuberculosis (TB) Day, UNAIDS is calling for the scale-up of integrated HIV and TB services, particularly in the countries and regions most affected by the dual epidemics. Worldwide, 9 million people developed TB in 2013 and 1.5 million people still die of the disease every year. TB entrenches poverty in many countries, with annual income falling by an average of around 50% among affected families.   

TB also remains a leading cause of death among people living with HIV. There were around 360 000 TB-related deaths in 2013 among people affected by HIV and about 1.1 million people living with HIV developed TB.  

However, if people living with HIV start antiretroviral therapy they reduce the risk of developing active TB disease. Early diagnosis of HIV and access to treatment reduces the risk of contracting TB by 65%. When treatment of latent TB infection is combined with antiretroviral therapy, the risk of developing active TB disease falls by about 90%.

If people living with HIV do develop active TB disease, immediate access to antiretroviral therapy and TB treatment (isoniazid preventive therapy) can reduce their chance of dying by 50%. Diagnosis of TB in people living with HIV and HIV testing for all people with presumptive and diagnosed TB are therefore crucial.

UNAIDS supports community-based efforts to build innovative and integrated approaches to HIV and TB that ensure that everyone has earlier access to HIV and TB prevention, testing and treatment services. By coordinating and intensifying efforts to support people living with HIV and TB, the epidemics can be reduced and ended in parallel. To do this, community support and mobilization will be crucial to increasing awareness about testing and treatment options and to strengthening health-care capacities.

A new strategy launched by the World Health Organization, Gear Up to End TB, proposes increased collaboration between TB and HIV services, the strengthening of health systems, the engagement of communities, improved social protection and intensified research and innovation. The strategy aims to reduce TB deaths by 95% and new cases of TB by 90% by 2035.

UNAIDS has established ambitious 90–90–90 treatment targets: 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment and 90% of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. UNAIDS is also working towards a Fast-Track Target of reducing new HIV infections to less than half a million a year by 2020.

UNAIDS will continue to work closely with countries, donors and partners, including the World Health Organization, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief, to produce sustainable solutions to fully integrate and deliver critical HIV and TB services.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.