Tuberculosis TB

GENEVA, 24 March 2014—On World Tuberculosis (TB) Day, UNAIDS is making an urgent call for global efforts to be stepped up to ensure earlier testing and treatment of TB and HIV. TB remains a leading cause of death among people living with HIV. In 2012, there were an estimated 1.1 million new cases of TB among people living with HIV—with 75% of new cases occurring among people living in Africa.

The dual impact of TB and HIV is devastating for millions of people and their families. This is unacceptable as TB is both preventable and curable. By expanding access to basic TB prevention for people living with HIV, the target of reducing TB deaths in people living with HIV by 50% can be reached by 2015.

Scientific studies have shown that early HIV diagnosis and access to treatment for HIV can reduce a person’s risk of TB by 65%. When treatment of TB is combined with ART, the risk of TB disease can be reduced by around 90%.

People in high-burden settings should have the opportunity to learn their HIV status and start treatment early in order to prevent active TB disease. If people living with HIV develop active TB disease then immediate ART can reduce their chance of dying by around 50%. Unfortunately, despite what is known about the importance of early diagnosis and treatment of both HIV and TB, millions of people often discover too late that they have HIV and TB.

UNAIDS launched Treatment 2015 to expand access to HIV treatment, which is important to both HIV and TB prevention efforts. UNAIDS is calling for an innovative, integrated effort to prevent HIV and TB—working together to increase resources and reach everyone living with HIV with key TB prevention interventions, including earlier access to HIV and TB testing and treatment.

UNAIDS is working closely with countries, donors and partners, including 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 to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

A special event to celebrate former President of Portugal Dr Jorge Sampaio’s commitment and dedication to raising the profile of public health and tuberculosis took place at the World Health Organization’s premises in Geneva on 15 April 2013. WHO Director-General, Dr Margaret Chan, the Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Mark Dybul and the UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures among others honoured Dr Sampaio for his efforts to advocate among global leaders for improved tuberculosis control. A discussion about the future of high-level political advocacy followed the initial remarks.

Dr Sampaio was appointed as UN Secretary-General Special Envoy to Stop Tuberculosis in 2006 and since the beginning he embarked on an ambitious programme to raise the visibility of the disease.  In 2008, Dr Sampaio convened the HIV/Tuberculosis Global Leaders' Forum where the co-infection of HIV/TB was defined as a major constraint to economic development and a barrier to social justice and human rights. The Forum managed to increase the engagement of global leaders in supporting the coordination of tuberculosis and HIV services.

Dr Sampaio has always been keen to highlight the crucial role played by civil society and affected communities in the response to HIV and TB. He expressed his personal support by visiting tuberculosis health centres in countries across the globe, including Brazil, Estonia, Ethiopia, Indonesia and Kenya amongst others.

L to R: UNAIDS Executive Director, Michel Sidibé and Dr Barnabas Sibusiso Dlamini, Prime Minister of Swaziland.
Credit: UNAIDS/J.Matas

Despite being one of the smallest countries in Africa, Swaziland has the highest percentage of people living with HIV anywhere in the world. More than a quarter of its adult population are living with the virus. Yet the people of Swaziland are facing not just one, but two deadly epidemics which intertwined are wreaking havoc throughout not only Swaziland but the whole of the sub-Saharan African region. Those epidemics are tuberculosis (TB) and HIV.

More than three-quarters of people who have TB in Swaziland are also living with HIV and an estimated 16 000 Swazis develop life-threatening, active TB disease every year. The combination of the two epidemics has made TB the leading cause of death in people living with HIV as the TB bacteria accelerates the progression of HIV infection to AIDS, weakening the body’s immune system until it can no longer fight disease.

But Swaziland is also determined to stop the epidemics in their tracks.

This week Swaziland played host to a powerful delegation of health leaders and experts committed to ending the dual epidemics of TB and HIV across the region. Convened by the Ministers of Health of both Swaziland and South Africa, supported by the Stop TB Partnership the meeting brought together brilliant minds and solid expertise to find ways of accelerating action to end the TB and TB/HIV co-epidemics in the countries of the Southern Africa Development Community (SADC).

“This is our last chance to put Africa back on track to achieve TB and HIV related targets,” said Dr Sibusiso Dlamini, Prime Minister of Swaziland stressing that progress towards the goal of reducing TB deaths in people living with HIV by 50% by 2015, set in the 2011 United Nations General Assembly Political Declaration on HIV and AIDS, was not moving fast enough.

Recognizing the importance of the challenge, Aaron Motsoaledi, Minister of Health of South Africa spurred participants to action, “You don’t set out to climb Everest expecting to fail,” he said. “We must set out expecting to succeed, no matter the size of the challenge ahead. Olympic athletes often come from far behind to win the race, we can do the same.”

The Everest he was referring to was the strong declaration of commitment which came out of the meeting––the ‘Swaziland Statement’. The statement highlights the determination of each of the partners to significantly cut TB/HIV related deaths over the next 1000 days and reach the 2015 goals.

“We need to lift up our expectations and raise our financial and technical contributions to realise the commitments we made to reduce the impacts of TB,” said Dr Lucica Dittu, Executive Secretary of the Stop TB Partnership.

Important commitments outlined in the statement include the full integration of TB and HIV services, new partnerships with non-traditional partners, a reinforcement of programmes and services and new and innovative methods of financing the response to the two diseases.

“A thousand people living with HIV die every day of TB on the African continent, this is unacceptable,” said UNAIDS Executive Director Michel Sidibé. “This initiative brings momentum, commitment and renewed energy which will produce results and improve the lives of millions of people across the region.”

UNAIDS pledged to continue working closely with its partners including the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure that everyone living with both HIV and active TB is able to start HIV treatment; that everyone in TB care is offered an HIV test; and that everyone in HIV care is offered screening for TB.  

UNAIDS Executive Director Michel Sidibé joined health leaders from Africa and other international organizations to support a new push to accelerate progress against tuberculosis and HIV. The initiative was unveiled at a press briefing in Johannesburg, South Africa on 20 March and will be formerly launched on 21 March in Mbabane, Swaziland.

The initiative includes a package of new investments worth more than US $120 million which will be used to expedite progress against TB and HIV in the next 1000 days. The initiatvie will work with South African Development Community (SADC) countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015.

Mr Sidibé and other health leaders will sign the Swaziland Statement in Mbabane at tomorrow’s formal launch of the initiative.

Most TB/HIV deaths can be averted if TB and HIV services work together more effectively and services are scaled up

GENEVA, 27 November 2012––Last week the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that there has been a 13% reduction in tuberculosis (TB)-associated HIV deaths in the last two years. The reduction is due to a sharp increase in the numbers of people with HIV and TB co-infection accessing antiretroviral therapy (ART)––a 45% increase between 2009 and 2011.

Yet TB remains the leading cause of death among people living with HIV. UNAIDS and the Stop TB Partnership have signed a new agreement to accelerate action to achieve the 2015 goal of reducing deaths from TB among people living with HIV by 50%. 

“We are losing precious lives to TB––which is a preventable and curable disease, and it is in our power to change this. The world will never reach its goal of an AIDS-free generation without tackling TB. It is time to act now,” said Benedict Xaba, Minister of Health of Swaziland, which has the world’s highest rate of TB among people living with HIV.

People living with HIV are 20 to 30 times more likely to develop active TB than people without HIV infection.  An estimated 8.7 million people became ill with TB worldwide in 2011, among whom more than 1 million were living with HIV. Pregnant women and children are particularly at risk. If a pregnant woman living with HIV also has TB disease, the risk of death for the mother and child is higher and the risk of HIV transmission to the child more than doubles. In 2011, 430 000 out of 1.7 million AIDS-related deaths (25%) were caused by HIV-associated TB disease.

“TB/HIV is a deadly combination.  We can stop people from dying of HIV/TB co-infection through integration and simplification of HIV and TB services”, said Michel Sidibé, Executive Director of UNAIDS. “The 2015 goals are clear­­­­—reduce TB deaths in people living with HIV by 50%––we can make this happen, but only if services are scaled up in countries through concerted and joint efforts.”

In 2011, at the United Nations High Level Meeting on AIDS, UN Member States set the target of halving TB/HIV deaths by 2015, which would lead to saving 600 000 lives. Three-quarters of TB/HIV deaths currently occur in just ten countries;  Ethiopia, India, Kenya, Mozambique, Nigeria, South Africa, the United Republic of Tanzania, Uganda, Zambia and Zimbabwe. Intensifying efforts in these 10 countries would significantly accelerate progress in achieving the 2015 goal.

“TB is preventable and curable at low cost, yet we still have one in four AIDS-related deaths caused by TB, and this is outrageous. Countries have yet to fully implement the actions needed to address the co-epidemic,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “Through a new agreement UNAIDS and the Stop TB Partnership have committed to a strong agenda of action, engaging new partners and assisting the most heavily affected countries as they integrate their HIV and TB services and build action plans.”

Preventing HIV/TB deaths

• In countries where HIV and TB are prevalent, testing for both should be provided to everyone.
• People living with HIV are far less likely to become ill with and die of TB if they begin antiretroviral therapy (ART) before their immune systems begin serious decline. All people who are eligible for ART should receive it as early as possible.
• In addition to earlier ART, people living with HIV should be protected against becoming ill with TB through a daily dose of the drug isoniazid.
• All people who test positive for HIV and are also found to have TB disease should start TB treatment immediately. After two weeks on TB treatment, they should begin ART, regardless of the status of their immune system.

Ms Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations, spoke during the show and reiterated UNAIDS’s commitment to working with partners in support of the global target to halve TB deaths in people living with HIV by 2015.
Credit: UNAIDS

Tuberculosis (TB) remains one of the leading causes of death among people living with HIV globally, yet TB is mostly preventable and curable. Reducing TB deaths in people living with HIV by 50% by 2015 is one of the 2015 global AIDS targets.

To give voice to TB and HIV affected communities around the world by sharing their experience and views on the way forward in the fight against the two diseases, a live web casted talk show took place during the International AIDS Conference entitled “Tuberculosis + HIV: Protecting the Vulnerable”.

The talk show was hosted by Jeanne Meserve, former CNN and ABC reporter, and Gerry Elsdon, the International Federation of Red Cross and Red Crescent Societies (IFRC) TB Goodwill Ambassador and a South African TV personality who suffered from tuberculosis in the past. The show brought together a dynamic group of women and young people who have suffered from tuberculosis and HIV, as well as the representatives of  multilateral organizations such as the Stop TB Partnership, WHO, IFRC, the Global Fund to fight HIV/AIDS, TB and Malaria, and UNAIDS.

The talk show also featured video addresses by Archbishop Tutu, who himself is a former TB patient and Jorge Sampai, UN Secretary-General Special Envoy for Tuberculosis.

Panelists took the opportunity to highlight the need for a closer collaboration between HIV and TB programmes, and about the urgent need for better investment in TB research. They also emphasized the need to invest more in integrating TB screening, treatment and care into antenatal care and maternal and child health services in general. Children most frequently get TB infection from a close relative, usually their mother, thus preventing, diagnosing and treating TB in women will reduce the risk of TB infection and disease in children.

Ms Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations, spoke during the show and reiterated UNAIDS’s commitment to working with partners in support of the global target to halve TB deaths in people living with HIV by 2015. She underscored that “UNAIDS advocates for TB service providers to reach many who are the most vulnerable and at risk, but who have the greatest problems in accessing services – migrants, indigenous people, prisoners, sex workers and women and children affected by poverty, violence, stigma and discrimination.“

The talk show was organized by the Stop TB Partnership and the International Federation of Red Cross and Red Crescent Societies.