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Political Declaration Target 5 - Tuberculosis
Halve tuberculosis deaths among people living with HIV by 2015
Concerted efforts have made the 2015 target possible: TB-related deaths have decreased by 36 percent worldwide since 2004. The World Health Organisation (WHO) claims that an estimated 1.3 million TB-related deaths have been averted between 2005 and 2012. Seventeen out of forty-one identified high-burden countries have reduced TB deaths amongst people living with HIV by over 50 percent. Additionally, the number of people with TB who received HIV testing in 2012 had increased by 14 percent from 2011.
However, this progress is beginning to level off. In some countries, mortality has decreased less or risen. Only two of the ten countries with the largest number of HIV/TB cases were delivering antiretroviral treatment to over 50 percent of HIV-positive people who also had TB in 2012. Globally, only 57 percent of people living with both illnesses received antiretroviral drugs (ARVs). It was also estimated that only 46 percent of TB patients were also being tested for HIV in 2012.
What still needs to be done?
- Scale-up the provision of antiretroviral treatment (ART). The focus on TB should be regarded as a very necessary part of the wider effort to scale up HIV treatment, and reduce the number of people who develop TB. Prompt HIV diagnosis and immediate treatment reduces the risk of developing TB by an estimated 65 percent and reduces the risk of death among people living with both HIV and TB by 50 percent.
- Create alternatives to ensure that essential drugs are affordable. As strands of TB can be multi-drug resistant, it is important to have alternative treatment methods available in high-prevalence areas.
- Implement routine HIV testing and counselling in TB care settings. This will help to improve early diagnosis in order to reduce the risk of people living with HIV developing TB.
- Fully implement the Three Is of HIV/TB. These refer to Intensified case finding, Isnoiazid preventive therapy and Infection control in clinical settings. Using these steps should greatly improve prevention efforts, as those currently receiving therapy are believed to be a small fraction of the number of people living with HIV who could benefit. Engaging communities can aid the uptake of these steps.
- Improve both completeness and accuracy of HIV/TB data. Increased integration between TB and HIV data collection systems will improve the coherence and quality and could also aid the facilitation of links between TB and HIV services.
- Introduce occupational health programmes for health care workers. This would meet the urgent need to ensure delivery of prevention interventions to workers who have been exposed to TB.
- Increase focus on the current blockages to providing an effective response to HIV-associated TB. These include poor uptake of prevention and treatment, not initiating ART immediately, a lack of HIV testing in TB clinics and a lack of infection control.
- Roll-out new testing technologies. An example is GeneXpert MTB/Rif, an automated molecular diagnostic test that diagnoses TB more rapidly.
- The global community is in reach of meeting the target: 101/109 reporting countries from mid-term reviews have integrated the target into national strategic plans.
- However, 26 countries are not making adequate progress to reach the target and need to scale up their efforts.
- It is important to emphasise that the 2015 target is only a step towards the larger goal of eliminating TB, and the efforts implemented must be continued after the target has been reached.