Coordinated action on TB and HIV

Jorge Sampaio, the United Nations (UN) Secretary-General’s Special Envoy to Stop Tuberculosis (TB), convened a meeting on June 9 in New York City at which activists and researchers called for integrated health services for people infected with HIV and TB in order to prevent TB from undermining the advances made in providing life-saving antiretroviral (ARV) treatment to more HIV-infected people, especially in Africa. Representatives at the meeting issued a “call for action” to the global community to better prevent, diagnose, and treat TB in HIV-infected individuals. 
HIV and TB are a deadly combination (see Deadly Duo: Joining forces to fight TB and HIV, IAVI Report, Nov.-Dec. 2006). TB is the number one cause of death among HIV-infected individuals in Africa. This bacterial infection also contributes to the death of one-third of the people who die of AIDS in low- and middle-income countries, said Kevin De Cock, director of the World Health Organization’s (WHO) HIV/AIDS department.

This HIV/TB meeting preceded a UN General Assembly High-Level Meeting on HIV/AIDS, which was held on June 10-11, also in New York City. The focus of this meeting was to review progress toward reaching the goal of achieving universal access to HIV prevention and treatment by 2010. On that front, UN Secretary-General Ban Ki-moon reported significant progress. At the end of 2007, three million people in low- and middle-income countries were receiving ARV therapy, a 42% increase over the previous year.

But even with this progress, there is still a long way to go in meeting the goal of universal access—only one-third of individuals currently in need are now receiving ARV therapy, according to the Secretary-General’s report on progress in the response to HIV. “There must be better access to prevention, treatment, and support services, especially for those populations at most risk,” said H.E. Srgjan Kerim, President of the UN General Assembly, in his closing statement to the High-Level Meeting. “We must not lose the momentum of our global response. For every two people that begin HIV treatment there are five new HIV/AIDS infections,” he added.

De Cock said progress toward universal access to ARV therapy should also involve access to TB prevention, treatment, and care since even individuals on ARV therapy are more vulnerable to TB. This requires successfully diagnosing TB in HIV-infected people, said Lucy Chesire, an HIV/TB activist. “We need to ensure that every person with HIV [is] screened for TB,” added Chesire. “We know that that’s not the case now. That’s why we [had] over 700,000 new HIV-associated TB cases in the last year.”

There are already examples of how coordinated HIV/TB efforts can make a difference, according to Mario Raviglione, director of the WHO’s Stop TB Department. In Kenya, for example, only 19% of individuals diagnosed with TB were also tested for HIV in 2004. This went up to 70% in 2007, he said, largely due to funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). “These are very good signs that this funding is being used properly to implement activities,” added Raviglione.

The “call for action” issued at the HIV/TB meeting requests that the global community mobilize an estimated US$19 billion to halve, by 2015, the number of HIV-infected people who die each year of TB, compared with 1990 levels. Of this, $14 billion would be spent on TB prevention and $5 billion on research, said Chesire. Part of the funding for research would go into developing better treatments for TB. There is an urgent need for better tools, such as drugs, said Raviglione. —Andreas von Bubnoff