Tuberculosis TB

UNAIDS welcomes the appointment by United Nations Secretary-General Ban Ki-moon of Eric Goosby as his Special Envoy on Tuberculosis. Dr Goosby will work on increasing efforts to end tuberculosis (TB) by keeping TB high on the global political and development agenda.

“I congratulate Dr Goosby and look forward to working with him in his new role as Special Envoy on Tuberculosis,” said Michel Sidibé, Executive Director of UNAIDS. “Dr Goosby’s knowledge and experience working on HIV and TB, together with his dynamic and committed leadership, will further strengthen our collaboration and bring us closer to ending the dual epidemics of HIV and TB.”

TB and HIV are inextricably linked. In 2012, people living with HIV accounted for 1.1 million (13%) of the estimated 8.7 million people who developed TB globally. TB remains a leading cause of death among people living with HIV. In 2013, 360 000 people living with HIV died of TB, a disease which is both preventable and curable.

Dr Goosby has led the United States of America’s global HIV efforts since 2009 when he was appointed as Ambassador-at-Large by President Barack Obama. Under his leadership, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) significantly developed its HIV programmes around the world, supporting millions of people living with and affected by HIV, many of whom were also living with TB.

UNAIDS has worked closely with Dr Goosby. In 2011, UNAIDS partnered with Dr Goosby and PEPFAR to spearhead the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Between 2009 and 2013, new HIV infections among children in the 21 Global Plan priority countries fell by 43%.

UNAIDS and Dr Goosby have also worked closely together on increasing country ownership of health responses as well as on efforts to strengthen health systems. A strong partnership with countries as they lead their response will continue to galvanize the global HIV and TB response.

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.

Health ministers from Brazil, Russian Federation, India, China and South Africa (BRICS) have committed to adopting the UNAIDS Fast-Track strategy to end the AIDS epidemic as a global health threat by 2030.

The decision was announced at a meeting of the ministers of health of the BRICS countries, held in Brasilia, Brazil, from 4 to 5 December. The ministers agreed to endeavour to achieve the 90–90–90 HIV treatment target by 2020, which is to rapidly reduce new HIV infections and AIDS-related deaths and to put countries on the Fast-Track to ending the AIDS epidemic by 2030. They also committed to ambitious tuberculosis (TB) targets and to advance cooperation and action on TB and HIV in the BRICS countries, such as the production of quality assured drugs and diagnostics for TB cases.

In 2013, the BRICS countries accounted for about 30% of new HIV infections worldwide. Estimates are that nearly half of all TB cases, 55% of multidrug resistant TB cases and 38% of all TB/HIV cases occur in the BRICS countries.

The adoption of the Fast-Track strategy by the health ministers demonstrates the renewed political commitment of the BRICS countries to work together to lessen the impact of TB/HIV coinfection. According to UNAIDS, the majority of people living with HIV will live in middle-income countries in the near future. In this regard, the BRICS countries can serve as a reference to provide solutions and exchange experiences with emerging economies.

UNAIDS Deputy Executive Director Luiz Loures called for an increased leadership by the BRICS countries to motivate the global community to implement the 90–90–90 treatment target and also fast-track the response to AIDS.

Tuberculosis (TB) remains a leading cause of death among people living with HIV. In 2013, 360 000 HIV-positive people around the globe died of TB, a disease which is both preventable and curable. Greater commitment and resources are needed to mount an effective response to TB and a high-level round-table event examined how this can be done through the new funding model of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

The event, which took place in Barcelona, Spain, on 30 October, provided an opportunity to exchange country experiences and information on TB financing and investing for impact. Participants also discussed the challenges and opportunities emerging from the new funding model, which promotes more strategic, flexible and predictable investment. 

On the opening panel, Global Fund Executive Director Mark Dybul was joined by South Africa’s Minister of Health, Aaron Motsoaledi, Blessi Kumar of the Global Coalition of TB Activists, USAID TB Senior Policy and Strategy Advisor Amy Bloom and UNAIDS Executive Director Michel Sidibé.

The panellists highlighted the importance of social movements and community engagement for more sustainable and inclusive approaches. They recognized the need for additional resources and called for more focused use of existing resources. It was also stressed that approaches to TB and HIV must be people-centred rather than disease-centred.

A new report on Tuberculosis (TB) released on 22 October by the World Health Organization shows that 9 million people developed TB in 2013, and 1.5 million died, including 360 000 people who were living with HIV.

The Global Tuberculosis Report 2014 highlights that while the number of TB deaths among people living with HIV has been falling for almost a decade—from 540 000 in 2004 to 360 000 in 2013—early case detection, antiretroviral treatment, preventive therapy and other key activities need to be further scaled-up.

According to WHO, one of the keys to reducing the number of deaths from HIV-associated TB is early case detection through the provision of HIV testing to all TB patients and routine TB screening among people attending HIV care. In 2013, 48% of TB patients had a recorded HIV test result and only half of those estimated to be co-infected with HIV-related TB were identified. Since 2012, WHO has recommended antiretroviral therapy (ART) for all TB patients testing positive for HIV within the first 8 weeks of initiation of TB treatment (and within 2 weeks of TB treatment for TB patients with profound immunosuppression). From 2012 to 2013, HIV treatment coverage among recorded TB patients rose encouragingly from 60% to 70% but this still represents less than a third of those estimated to be living with both TB and HIV.

Uptake of isoniazid preventive therapy (IPT)—which prevents people living with HIV from developing active TB—is rising slowly, the report finds. However, while the provision of IPT is increasing in Africa, only 21% of countries globally and 14 out of the 41 high burden TB/HIV countries reported provision of IPT to HIV positive people in 2013.

The implementation of collaborative TB/HIV activities has not evolved evenly across countries. The report stresses that further scale up of collaborative TB/HIV activities could be facilitated by joint TB and HIV programming, which would help to overcome constraints, promote synergies and achieve efficiency gains, especially between TB and HIV programmes.

WHO recommendations on the activities needed to prevent TB in HIV-positive people and to reduce the impact of HIV co-infection among HIV-positive TB patients have been available since 2004. These include establishing and strengthening coordination mechanisms for delivering integrated TB and HIV services; HIV testing for all patients with presumptive and diagnosed TB, providing antiretroviral therapy and co-trimoxazole preventive therapy to all HIV-positive TB patients, providing HIV prevention services for TB patients, intensifying TB case-finding among people living with HIV, offering IPT to people living with HIV who do not have active TB, and preventing the transmission of TB infection in health care and congregate settings.

The report concludes that despite encouraging progress, reaching the global target of halving deaths from HIV-associated TB is at risk, if countries don’t intensify the collaborative HIV/TB activities.

Over the past 10 years there has been significant progress in the response to HIV-related tuberculosis (TB), with a scale-up of integrated TB and HIV interventions saving an estimated 1.3 million lives between 2005 and 2011. However, tuberculosis accounted for some 320 000 AIDS-related deaths in 2012, and the vast majority of countries (more than 80%) are still not providing preventative TB drug therapy for those who need it.

A high-level consultation, held on 20 July during AIDS 2014 in Melbourne, Australia, gathered leaders in the global response to HIV to work towards eliminating TB deaths, stepping up the HIV response and achieving greater political commitment to this critical but often overlooked issue.

The meeting reviewed progress in regional and global responses and analysed gaps and barriers to achieving the elimination of TB/AIDS-related deaths, which include a critical need for point-of-care diagnostic tools for tuberculosis and the simplification of drug regimens. Participants also identified crucial next steps, such as opportunities to fill research gaps and promote much needed innovation.

Hosted by the World Health Organization (WHO), the session was chaired by Hiro Nakatani, Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, WHO. Participants included Gottfried Hirnschall, Director of the Department for HIV/AIDS, WHO, Mark Dybul, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, Ambassador Deborah Birx, United States Global AIDS Coordinator, Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, and Lucy Chesire, Executive Director, TB Action Group, as well as government representatives of Cambodia, India and Viet Nam.

African Heads of State committed to sustain efforts to ending AIDS, tuberculosis and malaria by adopting the recommendations stated in an AIDS Watch Africa report—including prioritizing AIDS, tuberculosis and malaria in the new development goals in order to ensure that the continued international financing of the response will not be threatened—during the twenty-third African Union Summit, held from 20 to 27 June in Malabo, Equatorial Guinea.

The report by AIDS Watch Africa, an Africa-led instrument to stimulate leaders into action and mobilize the resources needed to address AIDS, tuberculosis and malaria in an effective, sustainable and accountable manner, stresses the need for continued international support in the spirit of shared responsibility and global solidarity. However, it also stresses the importance of developing solutions towards innovative domestic financing for health, and urges countries to continue prioritizing rights-based responses.

During his visit to Equatorial Guinea, Michel Sidibé met with Teodoro Obiang Nguema Mbasogo, President of Equatorial Guinea, where he pledged to provide UNAIDS technical assistance in order to help achieve a more effective and coordinated response to HIV. Mr Sidibé also met with Uganda President Yoweri Museveni, who announced that he will send back to Parliament for revision the controversial HIV and AIDS Prevention and Control Bill 2010 introduced on 19 May.

While in Malabo, Mr Sidibé also participated in the extraordinary General Assembly of the Organisation of African First Ladies against HIV/AIDS (OAFLA). At the General Assembly, the First Ladies launched their activity report, which includes plans to minimize the number of women infected and affected by HIV in their countries, the role of traditional healers in achieving universal access to HIV treatment and the provision of free antinatal and postnatal check-ups for women.