FeedbackPeople living with HIV are about 14 times more likely to develop TB disease, have poorer TB treatment outcomes and have more than two-fold higher mortality during TB treatment, compared to all people diagnosed with TB (1).
The WHO End TB strategy (3), endorsed by the World Health Assembly in May 2014, provides the strategic direction for the achievement of TB targets within the UN Sustainable Development Goals (5), including the provision of universal health coverage to all people affected by TB. Integrated patient-centred care and prevention of HIV-associated TB are key components of the End TB strategy, which outlines a range of medical and socioeconomic interventions to prevent TB and address TB morbidity and mortality. The importance of integrated people-centred services was reiterated in the political declarations of the respective UN high-level meetings on the fight against TB (4) and on HIV and AIDS (5).
To support countries to reduce the burden of HIV-associated TB in populations at risk of or affected by both diseases, WHO published an Interim policy on collaborative TB/HIV activities in 2004 (9), which was updated in 2012 (10). The WHO-recommended collaborative TB/HIV activities outlined within the 2012 policy are listed in Fig. 1.
Fig. 1. 2012 WHO policy on collaborative TB/HIV activities (10)
The TB/HIV policy has served as a vehicle for a robust global response, advocating for further investment and scale-up of collaborative TB/HIV activities, and has provided guidance to Member States and other partners on effectively addressing HIV-associated TB. It is estimated that scale-up of these interventions between 2005-2022 has saved 9.2 million lives (1).² Yet, despite impressive uptake of collaborative TB/HIV activities and despite the advances in the prevention, diagnosis and treatment of TB disease, TB remains the leading cause of death among people living with HIV worldwide, accounting for 167 000 (27%) of global HIV-related deaths in 2022 (1). In addition, gaps in TB/HIV collaborative activities remain. In 2022, only 64% of new TB episodes among people living with HIV were diagnosed and notified, and the treatment success rate among people with HIV who started TB treatment in 2021 was 79%, lower than for all people with TB (1).
² To estimate the number of deaths averted by collaborative TB/HIV activities, the actual numbers of TB deaths can be compared with the number of TB deaths that would have occurred in the absence of antiretroviral therapy (ART) provided alongside TB treatment for people with HIV-associated TB. This number can be estimated conservatively as the number of estimated incident cases multiplied by the relevant estimated case fatality ratio for untreated HIV-associated TB. The estimates are conservative because they do not account for the impact of TB services or availability of ART or TB preventive treatment on the level of TB incidence; they also do not account for the indirect, downstream impact of these interventions on future levels of infections, cases and deaths.
