At this unique time in history when the world is grappling with the COVID-19 pandemic, the WHO Department of Global HIV, Hepatitis and STI Programmes stands in solidarity with governments and communities as they seek to maintain health services
and continue to address the needs of patients suffering from HIV and tuberculosis (TB).
Despite being preventable and treatable, tuberculosis remains the world’s biggest infectious killer and the leading cause of death among people living with HIV (PLHIV), responsible for 32% of the 770 000 lives lost to HIV in 2018. People
living with HIV are far more vulnerable (nearly 20 times more) to TB infection than people without HIV and are three times more likely to die during TB treatment.
While there are proven interventions that reduce TB deaths – such as provision of TB preventive treatment, adoption of novel diagnostics for earlier TB diagnosis and linkage to treatment, and antiretroviral therapy (ART) – we are far behind
in scaling these up, and diagnostic and treatment gaps remain, with only half of estimated TB cases among PLHIV reaching care in 2018, only half of estimated PLHIV with TB receiving ART, and less than half of PLHIV new on ART initiating TB preventive
treatment in a subset of countries which reported globally.
On this World TB Day, WHO highlights two key interventions to reduce unnecessary TB deaths among PLHIV:
- (1) provision of TB preventive treatment for all eligible PLHIV; and
- (2) increased uptake of newer diagnostic tests such as the lateral flow urine lipoarabinomannan assay (TB-LAM.)
As the new Director for the Department of Global HIV, Hepatitis and STI Programmes, I support current efforts to continue and to take to scale TB activities. It’s Time for solidarity! Let us work together to stop the needless deaths
due to TB among people living with HIV while we address the urgent need to protect PLHIV and TB from COVID-19 and care for them should they fall ill.
-Meg Doherty, Director Global HIV, hepatitis and STI Programmes, WHO
HIV programmes are encouraged to ensure that TB preventive treatment, including shorter WHO-recommended regimens, with updated guidance launched today, are provided to all eligible PLHIV as part of a routine package of care, including provision of ART, and that treatment completion is ensured.
In recent months, WHO has also released guidelines for use of a bedside urine TB-LAM test to accelerate earlier TB diagnosis, with significantly expanded eligibility criteria. As this test is “point of care” with the potential for earlier
TB diagnosis and treatment initiation, HIV programmes should consider these recommendations as they enhance strategies for TB diagnosis among PLHIV, including as part of a routine package of advanced HIV care.
It’s Time to urgently scale up TB preventive treatment and TB diagnosis and strengthen referral and linkages to TB treatment at HIV service delivery points in all countries and continue to scale-up ART among PLHIV with TB. This applies to all populations
at risk, including children, pregnant women and marginalized groups, to ensure no one is left behind.
WHO calls for continued collaboration in countries across health programmes for harmonized and integrated policies and service delivery, and engagement with communities and other sectors. Unless HIV programmes scale up interventions to close these
gaps in prevention, diagnosis and treatment both for TB and HIV, countries and their development partners will not meet our common target: a 75% reduction in TB deaths among PLHIV between 2010 and 2020. HIV mortality cannot be reduced without addressing
the leading cause: tuberculosis.