The need to scale up integrated TB/HIV care

26 September 2018

Global leaders met for the first United Nations High-Level Meeting on Tuberculosis on 26 September. The meeting was a critical moment to drive the delivery of political commitments and ensure a people-centred and coordinated tuberculosis (TB)/HIV response.

In the morning before the opening of the high-level meeting, affected communities, ministers of health, representatives of the United Nations, TB/HIV programme implementers and technical experts came together at a side event entitled No One Left Behind: Scaling Up Integrated People-Centred TB/HIV Care Towards Universal Health Coverage. The event provided a space to discuss the current challenges, gaps and opportunities in serving people and communities affected by TB/HIV and how each stakeholder has a unique opportunity to commit to increase the effort, overcome the barriers and scale up programmes and policies that work.

Approximately 10 million people fell ill with TB in 2017. The World Health Organization estimates that nearly a quarter of the world’s population has a latent TB infection. TB is the leading cause of death among people living with HIV, causing around a third of all AIDS-related deaths. While TB programmes generally have a very high HIV testing rate, HIV programmes are not testing, preventing and treating TB nearly enough.

The panel of practitioners and people affected by TB/HIV discussed what it takes to build an effective and sustained TB/HIV approach that delivers quality integrated care built on a strong community response. Speakers called for the response to be adequately funded and rights-based and firmly anchored in the universal health coverage agenda and the 2030 Agenda for Sustainable Development.

The speakers reiterated the critical importance of involving the users of health services in planning and implementing those services and staying accountable to the communities that are at the heart of the service delivery. They called for a break in the one client–two clinics model that has been the history of TB/HIV care in the past and agreed on the importance of people-centred care and both a funding environment and a government position that encourages local access and joint programming.


“Tuberculosis has no boundaries. Tuberculosis and HIV have affected and killed millions in the world. We cannot continue to do business as usual. We call on our governments to take a leading role in funding the response. Donors and national governments need to step up.”

Carol Nawina Nyirenda Executive Director, Community Initiative for Tuberculosis, HIV/AIDS and Malaria Plus Related Diseases

“Tuberculosis is not just a technical problem, it is a truly political issue. It is an issue of poverty, of people who have not been exposed to information and who have been left behind. We need to learn from what we did in the AIDS response and apply it to the response to tuberculosis. We cannot talk about achieving the Sustainable Development Goals if we continue to work in silos.”

Michel Sidibé Executive Director, UNAIDS

“One client–two clinics: this mould has to be broken. We need to change the clinics to be youth-friendly, men-friendly and friendly for women who are not pregnant—to get people into the clinics. We can’t have just words, the client has to be at the centre. Every minister of health needs to go back from this meeting and make their tuberculosis and HIV people work together.”

Deborah Birx United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy

“Why are so many people living with HIV dying from tuberculosis? The people most in need are the ones who are the ones who are left behind. We need new and improved medicines and diagnostics, new service delivery models based around what people and communities need, and integrated services for tuberculosis/HIV and other health issues.”

Tedros Adhanom Ghebreyesus Director-General, World Health Organization

“The people who have the most at stake are the ones who use the services. For governments not to understand that is a tragic mistake. We need to change the systems to the changing needs of people and create a more comprehensive and sustainable package of medical care for people. There is light at the end of the tunnel, but it’s a long tunnel.”

Eric Goosby United Nations Secretary-General’s Special Envoy on Tuberculosis