World TB Day: A call for greater integration of HIV and TB services
This World Tuberculosis (TB) Day, UNAIDS have called for a greater integration of HIV and TB services in order to combat the dual epidemics. In 2013, over 9 million people were diagnosed with TB, of which 1.1 million were also living with HIV. PLHIV are around 30 times more likely to develop opportunistic infections such as TB, with TB being the leading cause of death for PLHIV – among this group, 360,000 deaths can be attributed to TB alone.
For PLHIV, TB is harder to diagnose and progresses more quickly, and is more likely to be fatal if left undiagnosed or untreated. It can very quickly spread to other areas of the body (extra-pulmonary TB), and it is more likely to return after being successfully treated. Multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) are also more prevalent in areas where HIV prevalence is high, such as South Africa. These provide significant challenges in combating HIV and TB in these regions, as drug resistant strains are complicated and costly to treat.
UNAIDS champions HIV and TB programmes that are community-led, innovative and integrated with one another to ensure early access to prevention, testing and treatment services for both infections. In order to do this, there needs to be increased awareness about these services through strengthening community support and mobilisation, as well as strengthening healthcare systems to support these efforts. Their calls to action very much mirror a new strategy that was launched by WHO last week, called ‘Gear up to End TB’. In this report they call for greater integration of HIV and TB services and the strengthening of healthcare systems, as well as programmes to improve social protection, and further research and innovation into TB prevention and treatment. Their strategy aims to reduce TB deaths by 95 percent, and new TB infections by 90 percent by 2035.
It is absolutely vital that people living with HIV are screened for TB on a regular basis, and vice-versa. This is because when people are linked with antiretroviral treatment, they are more likely to fight off TB because they have a more powerful immune system. People living with HIV and who have an active TB diagnosis, can reduce their risk of dying by half when they are linked to HIV and TB treatment. Greater linkages of these services will mean earlier treatment initiation and reduced risk of death.