The Three I's for HIV/TB
Key interventions to decrease the impact of TB on people living with HIV
Key facts
- Tuberculosis (TB) is the leading cause of HIV-related deaths worldwide.
- Of the 1.7 million people who died from TB in 2009, 400,000 (24%) were living with HIV.
- Additionally in 2009 there were 9.4 million new cases of TB, of which 1.2 (13%) were among people living with HIV.
- The risk of developing TB is estimated to be between 20-37 times greater in people living with HIV than among those without HV infection.
Key interventions
There is a strong scientific evidence base supporting that ART, by lowering a person’s viral load and restoring the immune system, significantly reduces the impact of HIV and TB. WHO recommends earlier ART at <350 CD4 and the immediate initiation of ART for all TB patients irrespective of CD4 count.
The Three I's for HIV/TB
In addition to initiating earlier antiretroviral therapy (ART), WHO recommends the implementation of the Three I's for HIV/TB to reduce the burden of TB among people living with HIV:
- Intensified TB case finding
- Isoniazid preventive therapy
- Infection control for TB.
As resource-constrained countries rapidly expand HIV services prevention, treatment and care of TB in people living with HIV is an urgent priority for both HIV/AIDS and TB programmes. WHO recommends that the Three I's for HIV/TB in addition to ART be part of a TB prevention package and that emphasize that they should be core components of HIV services with AIDS programmes and service providers taking the primary responsibility for the Three I's for HIV/TB.
Related documents
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Report of the KELIN-WHO Community Workshop to accelerate the implementation of the Three I’s for HIV and TB in East Africa
28 November - 1 December 2011, Nairobi, Kenya -
Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings
2011 -
WHO policy on TB infection control in health-care facilities, congregate settings and households
2009