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New Report Shows Under-resourced TB Programs Bearing Burden of TB-HIV Response

"People are living with HIV but dying of TB more than ever before, yet many of these deaths are entirely preventable. Donors and high-burden countries can save thousands of lives every year by implementing and funding integrated programs for the two diseases. This report takes a timely look at the progress being made to tackle the twin epidemics of TB and HIV and the answer is clear:  not enough. We know what needs to be done and now governments must do it."

– The Right Honorable Nick Herbert, Member of Parliament
Co-chair of the United Kingdom All-Party Parliamentary Group on Global TB
Co-chair of the Global TB Caucus

In 2015, TB (tuberculosis) surpassed HIV as the world’s leading infectious killer, in part, because progress against both epidemics has been held back by a failure to coordinate. The two epidemics fuel each other, but the global response has missed opportunities to use that linkage to catalyze faster progress against the "deadly duo" of TB-HIV. At the 2016 International AIDS Conference in Durban, South Africa, ACTION launched a report, From Policy to Practice, which shows how the global TB-HIV response is working.

What have we learned about the TB-HIV Response?

Building on ACTION’s 2014 report, From Rhetoric to Reality, this updated analysis details the steps that governments of countries with high burdens of TB-HIV and their donor partners have taken to turn a coordinated response to TB-HIV into reality at the country level, as well as the remaining gaps. Using the World Health Organization’s (WHO) list of 12 evidence-based priority coordinated activities as a guide, ACTION used document reviews and stakeholder interviews to assess how the global response can take the next step from policy to practice.

As global guidelines to combat TB-HIV were updated and formalized, countries did begin moving from rhetoric to reality, adapting WHO’s recommendations to country realities and expanding lifesaving TB-HIV collaborative activities (see graph; click to enlarge).

Updates in Global Guidelines and Improvements in Lifesaving TB-HIV Activities

For example, in 2014, 77 percent of people living with HIV who were also diagnosed with active TB were placed on ART. However, at the same time, opportunities were being missed:  only 47 percent of people enrolled in HIV care were screened for TB, only 51 percent of people diagnosed with TB were tested for HIV, and only half of the estimated number of people living with HIV who developed TB were accurately diagnosed and provided care. The report highlights the need for the HIV and TB communities to join forces and finally give this deadly issue the attention it deserves.

"ACTION’s research will allow the international community to identify good practices, lessons learned, and key challenges in order to achieve an effective response to this serious public health threat."

– Awa Marie Coll Seck, Minister of Health and Social Action,
Ministry of Health and Social Action of Senegal

What can we do to improve the TB-HIV response?

  • Global partners—governments, donor agencies, civil society, and the private sector—must work together to address key gaps, such as human resource capacity and the development and scale-up of appropriate tools, in the prevention, diagnosis, and treatment of HIV-associated TB.
  • The governments of high-burden countries should develop joint national TB and HIV strategic plans (like those South Africa has successfully pioneered), hold national HIV programs accountable for results from TB-HIV collaborative activities, prioritize and scale up investments in underfunded TB programs and health worker support, engage civil society and private sector stakeholders, and improve data collection and reporting on TB-HIV.
  • The Global Fund to Fight AIDS, Tuberculosis, and Malaria (The Global Fund) should ensure that single TB-HIV concept notes (a requirement that grant funding applications include both TB and HIV) result in joint programming, by encouraging national HIV and TB program budgets to more accurately reflect the cost of carrying out joint activities, and continuing to invest in innovative programs, such as community extension workers and improved data collection.
  • U.K. Department for International Development (DfID) should clearly and publicly commit itself to a specific role in promoting TB-HIV integration and ensure that investments in health systems include appropriate TB-HIV collaborative activities.
  • U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) should continue to be a leader in investing in high impact TB-HIV interventions and work with governments and other donors to ensure sustainability of programming in areas outside HIV "hot spots."
  • The World Bank should continue to support governments with critical infrastructure investments, particularly laboratory capacity, and promote best practices in TB-HIV coordination within health systems by strengthening investments and technical assistance.

Sources for the graph:
- Data on TB patients tested for HIV and TB-HIV patients on ART from WHO Global Tuberculosis Program database 16, June 2016.
- Data on the TB screening numerator come from WHO Global Tuberculosis Report 2015 data set (2004–2014).
- Data on the TB screening denominator for the number of people on ART was retrieved from UNAIDS publications http://aidsinfo.unaids.org/, http://www.who.int/3by5/pr_en.pdf?ua=1, http://data.unaids.org/pub/GlobalReport/2006/200605-FS_globalfactsfigures_en.pdf, and http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/20130923_FactSheet_Global_en.pdf.