On this World AIDS Day, we celebrate the contribution of communities to the HIV response. Community health workers and civil society organizations play a singular role in combatting stigma and discrimination, as well as in expanding access to testing and treatment of HIV worldwide.
As we ramp up global efforts to tackle the TB epidemic, including among those living with HIV, this is the very force we need to harness. The participation and advocacy of communities will ensure that the spotlight remains on the End TB response and that this response is people-centred.
Taking stock
Scale-up of collaborative TB/HIV activities is estimated to have saved around 7.3 million lives since 2005.
According to the WHO Global TB Report, 64% of TB patients knew their HIV status in 2018, up from 35% in 2010. The African region, which accounts for the bulk of the TB/HIV burden, reported 87% coverage. Last year, 86% of TB patients with HIV were started on antiretroviral treatment (ART). We have also seen an impressive scale-up of TB preventive treatment (TPT) among people living with HIV. In 2018, 1.8 million people living with HIV were enrolled in TPT across 65 countries, putting us on track to meet the target of reaching 6 million people living with HIV with TB preventive services by 2020, as set in the political declaration of the UN high-level meeting on TB .
While we have impressive progress to celebrate, much more remains to be done. Latest WHO estimates show a 52% decline in TB deaths among people with HIV since 2010, far short of the progress needed to achieve a 75% reduction in deaths by 2020 -- a target in the 2016 UN Political Declaration on Ending AIDS.
TB remains the number one killer of people living with HIV, accounting for a third of AIDS deaths in 2018. Among those living with HIV who fell ill with TB, shockingly, 44% did not receive TB care and 52% did not receive HIV care.
Looking forward
We have the policies and innovations to make the difference. We now have shorter and more friendly regimens to simplify TPT. Experience from countries such as India, South Africa and Uganda has shown that rapid scale-up and catch-up of TPT among people attending HIV care is feasible. Technologies such as Xpert and Xpert Ultra, and LF-LAM promise to fast-track TB detection. Experiences from different settings have shown that integrated TB and HIV service delivery increases HIV testing and ART coverage.
In a nutshell, there are untapped opportunities – but we need to do our best to get these innovations to patients. Universal access to health services, including integrated TB and HIV services, is a must. We need to ensure that no one is left behind. And for this to happen, we need to address socio-economic barriers including stigma, discrimination, criminalization and financial costs that preclude people from accessing care.
Communities make the difference
The HIV response has taught us that communities play a critical role in catalysing change. As we mark this year’s World AIDS Day with the theme “Communities make the difference”, we need to harness the power of communities to end TB and HIV by 2030, as set forth in the Sustainable Development Goals.
In closing, I would like to bring to your attention the rousing words of my colleague and member of WHO’s Civil Society Task Force on TB, Jeffry Acaba. Jeff is a young leader who galvanizes both the TB and HIV communities in the Asia-Pacific and worldwide. Earlier this year, at a side-event on TB at the UN General Assembly, he said “Civil Society and TB affected communities are the backbone of an inclusive and responsive TB response but without systematic and sufficient support for TB communities, we will never get to end TB”. He added, “2.3 million people living with HIV around the world are eligible to access TB prevention but for many reasons, are not able to do so....if we work together and you allow us (communities) to lead the way, we can eventually close the gaps and end the TB epidemic”.
We, at the WHO Global TB Programme, stand with Jeff and others in the TB and HIV communities. We pledge to do our best, with respect and in collaboration, to build a better world free of needless suffering and death.
Best regards,
Dr Tereza Kasaeva
Director
Global TB Programme
WHO