Even though tuberculosis (TB) is preventable and curable, it is the top infectious killer worldwide, claiming around 4400 lives a day. TB also remains the leading cause of death among people living with HIV, causing one in three AIDS-related deaths. However, progress has been made―TB-related deaths among people living with HIV peaked in 2005, at 600 000 deaths; since then, they have halved, to 300 000 in 2017.

Countries pledged in the 2016 United Nations Political Declaration on Ending AIDS to reduce TB deaths among people living with HIV by 75% by 2020. By 2017, five low- or middle-income countries had achieved or exceeded that target―a further 18 countries reduced TB deaths among people living with HIV by more than 50% and are on track to achieve the target by the end of 2020, provided that scale-up of services is maintained. However, the estimates also show that most countries are not on track and that deaths are rising in some regions and countries.

Leaders from both the private and public sectors have called for fresh investment models for new technologies and the smarter roll-out of innovations to end AIDS and tuberculosis by 2030.

The plea was made by panellists taking part in a debate at the Health Innovation Exchange, a three-day event organized by UNAIDS and held between 21 and 23 May on the sidelines of the World Health Assembly in Geneva, Switzerland.

Speaking at the event, the Executive Director of the Stop TB Partnership, Lucica Ditiu, said new approaches are vital in order to make faster progress in the response to the epidemics.

“We will not achieve our targets of ending AIDS and tuberculosis by doing things as we have always done them in the past,” she said. “Products must be developed with the patient in mind and we must work with developers to help them gather evidence that their innovations work in order to shorten the timeline from validation to implementation.”

Roland Göhde, chair of the German Healthcare Partnership, a joint venture of the Government of Germany and the Federation of German Industries, said there was an urgent need for greater synergies right along the chain of development and innovation. “The private sector needs to be systemically involved by other sectors. We need to bundle and conflate the different expertise of the involved sectors to get rid of fragmentation.” 

Mr Göhde also underlined the importance of training in new technologies. He described how the German Healthcare Partnership had facilitated the training of laboratory workers in Burkina Faso in new haematology technologies as well as the training of biomedical engineers in Kenya and Senegal.

Jenifer Healy from USAID reminded the audience that the World Health Organization had estimated that the cost of achieving the Sustainable Development Goals health targets was an initial US$ 134 billion annually in 2017, rising to US$ 371 billion by 2030.

“While we have made great progress in global health, including in reducing the impact of AIDS, the funding gap for new investments will triple by 2030,” she said.

The Global Head of Public Health at Johnson & Johnson, Jaak Peeters, also underlined the importance of supporting the best science possible for global health, a more rapid implementation of best practice innovation and the fullest embrace of public–private collaboration.

In his comments, the Director-General of the Ghana Health Service, Anthony Nsiah-Asare, said that political commitment was required to ensure that innovation was deployed to deliver smarter, more efficient and high-quality services to the people most in need.

Tuberculosis (TB) is the world’s number one cause of death from an infectious disease and remains the leading cause of death among people living with HIV, despite being preventable and curable. Reacting to the unacceptable burden of disease and death caused by TB, a new network of TB survivors and affected communities, called TB People, compiled the Declaration of the Rights of People Affected by Tuberculosis, with the support of leading human rights lawyers and the Stop TB Partnership.

The declaration, launched on 14 May at the Global Health Campus in Geneva, Switzerland, will guide countries to implement the commitments made at the 2018 United Nations High-Level Meeting on Tuberculosis and will inform the last board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) before its replenishment meeting in Lyon, France, in October.

“Too many people have been buried whose lives could have been saved if their rights had been protected,” said Maurine Murenga, communities representative on the board of the Global Fund. “Too many children have survived and been cured of tuberculosis only to be forced to sit isolated on one side of their classroom with their classmates on the other side,” she added.

The lack of human rights protections makes people more vulnerable to developing TB disease, negatively affects their ability to access effective treatment and exposes them to stigma and discrimination by the very fact of having TB. TB-related human rights violations include failures to diagnose or treat people properly, restricted access to health information by people living with TB and shackling prisoners accessing TB treatment in hospital.

For the first time, the rights of people affected by TB that are enshrined in existing global and regional human rights laws are listed in one declaration alongside an explanation of their relevance for people affected by TB. This innovative declaration aims to inform and empower people and communities affected by TB to be able to claim and protect their right to a life free from TB and when necessary to ensure equitable access to quality TB prevention, diagnosis and treatment, free from stigma and discrimination.

“Communities must be put at the centre of the response to tuberculosis ”, said Shannon Hader, UNAIDS Deputy Executive Director, Programme, adding that, “People have the right to science and to be empowered to demand access to the most effective tuberculosis medicines, diagnostics and vaccines—those available now and those we’re striving to create for the future.”

The declaration also seeks to ensure that governments and other service providers are aware of their commitments and obligations to protect and promote the rights of people affected by TB.

During the launch of the declaration, many TB survivors, activists and partners shared stories about how TB and the denial of their rights had directly affected them or their families, including Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, whose brother almost died from TB for fear of the stigma that surrounds the disease.

Rhea Lobo from TB People described her harrowing experience of having bone TB. The report on her initial bone samples was lost for several months. She was denied a copy of the results so that she could not seek a second opinion and had to resort to smuggling the results out to photocopy and return them. A new doctor discovered that she had been given the wrong treatment dose for six months, putting her at risk of developing drug-resistant TB.

The declaration was dedicated to the memory of Dean Lewis, a tireless activist for the rights of people living with TB and people who use drugs, who had suffered several episodes of TB. Dean was among the core group who conceived and compiled the declaration but died before its completion, owing to the lack of the health services he needed.

Five countries met the target three years ahead of the 2020 deadline and 18 more are on track; however, most countries are lagging behind and risk missing the target completely. UNAIDS urges countries to step up action.   

GENEVA, 22 March 2019—Ahead of World Tuberculosis Day, on 24 March 2019, UNAIDS is urging countries to step up action to meet the 2020 target of reducing tuberculosis (TB) deaths among people living with HIV by 75%, as outlined in the 2016 United Nations Political Declaration on Ending AIDS. World Health Organization estimates show that, globally, TB deaths among people living with HIV have fallen by 42% since 2010, from 520 000 down to 300 000 in 2017.

The estimates show that, by 2017, five low- or middle-income countries achieved or exceeded the target of a 75% reduction in TB deaths among people living with HIV, three years ahead of schedule—India (84%), Eritrea (83%), Djibouti (78%), Malawi (78%) and Togo (75%). A further 18 countries reduced TB deaths among people living with HIV by more than 50% and are on track to achieve the target by the end of 2020, provided that scale-up of services is maintained. However, the estimates also show that most countries are not on track and that deaths are rising in some regions and countries.

“TB should be a disease of the past. It has been treatable and preventable for decades. Years of neglecting the rights of the world’s poor to basic health care, food and shelter have let TB take hold and allowed resistance to build,” said Michel Sidibé, Executive Director of UNAIDS. “People living with HIV are especially at risk. There is still a chance for many countries to meet the target, but we have to act now―it’s time to end TB and AIDS.”

Around 40 countries showed a rise in the number of TB deaths among people living with HIV between 2010 and 2017. In eastern Europe and central Asia, the number of TB deaths among people living with HIV increased by 22% between 2010 and 2017, with increases being seen in all but three countries in the region. In Latin America, deaths rose by 7%. The lack of progress in some countries is a clear indication that further efforts are needed to address the main challenges, including the need for equity and ensuring that vulnerable groups have access to integrated HIV and TB services.

To accelerate progress in reducing TB deaths among people living with HIV and reach the 2020 target, UNAIDS is urging countries to fully integrate TB and HIV services and to use community-based approaches to find, diagnose and treat the missing cases. Countries need to screen all people living with HIV for TB and all people with TB need to be tested for HIV. The quality of TB and HIV diagnosis also needs to be improved. HIV and TB prevention efforts need scaling up, particularly for people at higher risk of infection. In addition, all people diagnosed with TB and HIV need immediate access to treatment and support to adhere to their treatment regimens.

“Although progress is mixed, we can see that the target can be met, and a large number of countries can get there if they act with urgency and use focused community-based approaches,” said Mr Sidibé. “I cannot stress enough how critical it is to integrate TB and HIV services so that people can be screened, tested, treated and offered prevention for both diseases, ideally under the same roof, by the same health worker and on the same day. This is an approach that we know saves lives.”

With less than two years to achieve the target, UNAIDS is urging all countries to step up action and partners to work together to ensure that all people affected by HIV and TB have access to effective prevention and treatment services.

TB is the top infectious killer worldwide, claiming around 4400 lives a day. TB also remains the leading cause of death among people living with HIV, causing one in three AIDS-related deaths. In 2017, 1.6 million people died from TB, including around 300 000 people living with HIV.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Faith-based organizations have long played a critical role in the response to tuberculosis (TB). Many faith-based health service providers have implemented effective TB/HIV responses modelled on decades of work on TB. Today, faith-based organizations are delivering effective, high-quality TB/HIV services that complement national public health programmes in the countries most affected by TB and HIV.

Successful TB/HIV responses address both the biomedical and the social determinants that underpin these illnesses, such as poverty, inequality, situations of conflict and crisis, compromised human rights and criminalization. Children and adolescents are particularly vulnerable to infection and the impact of TB/HIV on their families. Because they have positions of trust at the heart of communities, faith-based organizations can provide services and support that extend beyond the reach of many public sector health systems.

To provide an opportunity to strengthen relationships and forge new partnerships, on 27 September the World Council of Churches–Ecumenical Advocacy Alliance, in collaboration with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Interagency Task Force on Religion and Development, hosted an interfaith prayer breakfast on the sidelines of the 73rd Session of the United Nations General Assembly in New York, United States of America. Keynote speakers and table discussions focused on the outcomes of the United Nations High-Level Meeting on Tuberculosis, which took place on 26 September, and examined how the longstanding experience of faith-based organizations in responding to TB/HIV can support the new declarations agreed by Member States during the historic high-level meeting.

The participants included faith leaders and health service providers from different religious traditions. Survivors of multidrug-resistant TB brought a powerful sense of urgency and reality to the discussion. The participants renewed their call to national governments to not only maintain, but increase, support in order to end AIDS and TB as public health threats by 2030.

Quotes

Global leaders met for the first United Nations High-Level Meeting on Tuberculosis on 26 September. The meeting was a critical moment to drive the delivery of political commitments and ensure a people-centred and coordinated tuberculosis (TB)/HIV response.

In the morning before the opening of the high-level meeting, affected communities, ministers of health, representatives of the United Nations, TB/HIV programme implementers and technical experts came together at a side event entitled No One Left Behind: Scaling Up Integrated People-Centred TB/HIV Care Towards Universal Health Coverage. The event provided a space to discuss the current challenges, gaps and opportunities in serving people and communities affected by TB/HIV and how each stakeholder has a unique opportunity to commit to increase the effort, overcome the barriers and scale up programmes and policies that work.

Approximately 10 million people fell ill with TB in 2017. The World Health Organization estimates that nearly a quarter of the world’s population has a latent TB infection. TB is the leading cause of death among people living with HIV, causing around a third of all AIDS-related deaths. While TB programmes generally have a very high HIV testing rate, HIV programmes are not testing, preventing and treating TB nearly enough.

The panel of practitioners and people affected by TB/HIV discussed what it takes to build an effective and sustained TB/HIV approach that delivers quality integrated care built on a strong community response. Speakers called for the response to be adequately funded and rights-based and firmly anchored in the universal health coverage agenda and the 2030 Agenda for Sustainable Development.

The speakers reiterated the critical importance of involving the users of health services in planning and implementing those services and staying accountable to the communities that are at the heart of the service delivery. They called for a break in the one client–two clinics model that has been the history of TB/HIV care in the past and agreed on the importance of people-centred care and both a funding environment and a government position that encourages local access and joint programming.

Quotes

The World Health Organization recently released its Global tuberculosis report 2018. Although it shows encouraging pockets of progress in responding to tuberculosis (TB) and HIV in some areas, it paints a rather bleak picture on ending the dual epidemics by 2030.

HIV is a relatively recent epidemic, having first been identified in the early 1980s; however, TB has been around for thousands of years. Archaeologists believe that TB affected the ancient Egyptians, with King Tutankhamun himself having possibly been affected.

Many famous people have fallen ill or died of TB over the years, including John Keats, Frédéric Chopin, Charlotte and Emily Brontë, Nelson Mandela and Franz Kafka, to name but a few. In the early twentieth century, supposed cures for TB included day-long bracing outdoor siestas in Swiss mountain sanitoriums, freezing cold showers and diets of up to 12 meals a day washed down with litres of milk and wine, and even staying in cowsheds, where the warmth and ammonia gases given off by the animals’ urine was supposedly a balm for infected lungs.

Effective medicinal treatment for TB became available in the mid-1940s and has changed little since. Today’s medicine, although toxic and antiquated, is incredibly effective and relatively cheap. However, finding people with TB to treat and ensuring that they stay on treatment poses problems and is particularly urgent for people living with HIV.

The World Health Organization estimates that in 2017 there were around 10 million people with active TB disease, 9% of whom were people living with HIV. Of the 10 million, approximately 3.6 million, or 36%, are “missing”, meaning that they may not have been diagnosed or properly treated. Among people living with HIV, the gap is wider, at 49%.

People living with HIV with latent TB are around 20 times more likely to develop active TB. Untreated TB is rapidly fatal among people living with HIV.

Fewer than 60% of TB patients are screened for TB, precluding treatment and resulting in preventable deaths. TB is the leading infectious killer globally and the leading killer of people living with HIV, accounting for one in every three AIDS-related deaths. In 2017, around 1.6 million people died of TB, including 300 000 people living with HIV.

Many breakthroughs can be achieved by improving collaboration between HIV and TB programmes to find and treat TB and HIV, including investing in diagnostics, vaccines and medicines, including preventive medicine and medicine to treat TB, including multidrug-resistant TB.

However, more commitment, investment and action are needed.

It is estimated that US$ 10.4 billion is required in 2018 for an effective response to TB in the 118 low- and middle-income countries that account for 97% of reported cases globally. The actual amount available in 2018 was US$ 6.9 billion—a shortfall of US$ 3.5 billion.

To respond effectively to HIV, UNAIDS estimates that US$ 26.2 billion will be required for the AIDS response in 2020. In 2017, US$ 21.3 billion was available in low- and middle-income countries—a shortfall of around US$ 5 billion. Only by filling the funding gaps will ending the epidemics start to become a reality.

With around 1.7 billion people, or 23% of the world’s population, infected with latent TB, of whom 5–10% have a chance of developing active TB disease, the world needs to take urgent action.

On 26 September, world leaders will come together at the United Nations in New York, United States of America, for the very first United Nations High-Level Meeting on Tuberculosis. As TB takes centre stage for one important day, the world has the opportunity to set some bold actionable targets to end two of the world’s leading infectious killers: TB and HIV.

To seize this opportunity would not only stop more than 6000 people dying every day from TB and HIV, but it would prevent new infections and bring the world a giant leap closer to improving global health, reducing poverty and achieving the Sustainable Development Goals.