GENEVA, 23 March 2018—Ahead of World TB Day 2018, UNAIDS is calling on all partners to take unprecedented and bold action to advance efforts to end tuberculosis (TB) and AIDS by 2030.

TB continues to be the top infectious killer worldwide, claiming more than 4500 lives a day. TB is also the leading cause of death among people living with HIV, causing one in three AIDS-related deaths. In 2016, 1.7 million people died from TB, including around 374 000 people living with HIV.

“The world has the resources to end the interlinked epidemics of tuberculosis and HIV, but political commitment and country action are lacking,” said Michel Sidibé, UNAIDS Executive Director. “Political, religious and civil society leaders need to step up to guarantee everyone the right to breathe, to live free from tuberculosis and AIDS.”

TB is preventable and curable; however, persistent challenges remain. Many of these challenges are also faced by the HIV response and can be effectively addressed if programmes are integrated. They include unequal access to services, with the most marginalized people still out of reach, the need to access education, housing and basic services to prevent, diagnose and treat TB and HIV through local health-care services and community health-care workers, the need to strengthen health systems and the urgent need to mobilize resources in programming, research and development.

To address the challenges and push forward the response to TB and HIV, UNAIDS has outlined five important actions for partners:

• Give a new impetus to the response to TB and HIV by impelling political, religious and civil society leaders to champion the universal right to live free from TB and HIV, building on existing rights and health and social movements.
• Empower communities to demand their right to health. Affected communities must call on governments to improve living standards, including by accessing nutritious food, breathing clean air, completing their education and fostering an enabling economic environment, all of which will help to reduce the burden of TB and HIV.
• Ensure rights-promoting and non-discriminatory service delivery for all, especially for people at higher risk of TB and HIV, such as children and marginalized populations, to protect them against catastrophic health expenditures in the context of universal health coverage. Thus, duty of care extends beyond health to include safe workplaces and places of detention.
• Engage ministers of finance to approach health as an investment, not an expenditure. While the above actions carry some financial outlays, assessments of returns on investment in health have demonstrated their long-term value to societies and economies. An efficient and effective response to HIV and TB will require working across all ministries and sectors to mobilize sufficient domestic financing to strengthen health systems.
• Innovate for new medicines and vaccines. Greater partnerships between the public and private sectors are urgently needed to accelerate innovation that leads to the discovery, development and rapid uptake of new tools to prevent and treat TB and HIV, as are strategies for shorter and less-toxic TB regimens.

Ending the global TB and HIV epidemics is possible. HIV is preventable and effective and affordable treatment is available. TB is preventable, treatable and in most cases curable.

Progress has been made—deaths from TB among people living with HIV declined by 37% between 2005 and 2016 as prevention, testing and treatment have improved and increased. However, there is still much more work to be done.

In September 2018, world leaders will come together at the United Nations in New York, United States of America, for the first-ever United Nations General Assembly High-Level Meeting on Tuberculosis. This meeting will be an important opportunity for countries to adopt a progressive, visionary and actionable political declaration on TB.

“The United Nations High-Level Meeting on Tuberculosis could provide the political, social and financial momentum needed to end TB,” said Mr Sidibé. “This year could be the most important since Robert Koch discovered the cause of TB136 years ago, but only if we all show leadership.” 

UNAIDS urges all partners to ensure that TB is elevated on global, regional, national and subnational political and social agendas, that TB and HIV are addressed in unison and that partners combine robust efforts to end TB and HIV by 2030 as part of the Sustainable Development Goals.

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.

The year 2018 is critical for the international community as it pushes progress towards ending the global tuberculosis (TB) epidemic by 2030 as part of the Sustainable Development Goals.

In September 2018, United Nations Member States will come together in New York for the United Nations High-Level Meeting on Tuberculosis to show their political leadership and commitment to ending TB by 2030. Some of the main challenges in the response, including the need for equity and to ensure vulnerable groups have access to TB services, will be addressed at the high-level meeting, as will the need to make TB testing and treatment available through primary health-care services and the urgent need to mobilize resources.

In preparation for this historic event—the first ever United Nations high-level meeting on TB—leaders from across the globe converged in New Delhi, India, on 14 and 15 March, for the End TB Summit, part of which was the 30th Stop TB Partnership Board Meeting.

A large number of global leaders on TB gathered at the meeting. J. P. Nadda, the Union Minister of Health and Family Welfare, India, said during the event, “We will ensure that commitments to end tuberculosis made are fulfilled. Achievement of the goals will need innovations as well as new implementation ideas. India stands committed to support neighbouring countries in the fight against the disease.”

In 2016, the estimated funding gap for TB programming was US$ 2.3 billion. In addition, there was a US$ 1.2 billion shortfall in TB research and science. The urgent need for increased investments in innovation will be highlighted in the lead-up to the high-level meeting as part of efforts to bring 21st century diagnostics and treatments and a vaccine to the response to TB.

“Leaders across the globe need to seize this opportunity, make bold commitments and take a resolve to see the end of tuberculosis on a fast track. Actions to follow the commitments will need bold actions by health ministries, other ministries, the private sector, civil society and communities,” said Isaac Folorunso Adewole, the Minister of Health of Nigeria.

TB has been around for thousands of years, yet TB still remains a major global health crisis. The World Health Organization estimated that in 2016 around 1.3 million people died of TB and that a further 400 000 people living with HIV died from TB/HIV coinfection (reported globally as AIDS-related deaths).

“We cannot eliminate tuberculosis with only a top-down approach. We must work together to empower communities to support the fight against tuberculosis. This movement must go far beyond the medical community,” said Soumya Swaminathan, the Deputy Director-General of the World Health Organization.

People living with HIV are particularly affected by TB. One in 10 TB cases occurs among people living with HIV and one in four TB deaths is associated with HIV. Despite being preventable and curable, in 2016 TB was the ninth leading cause of death worldwide.

“There are a lot of people still not accessing treatment. We need to look at strategies to increase access to care, particularly for those most marginalized and not accessing care right now,” said Tim Martineau, the Deputy Executive Director, a.i, at UNAIDS.

UNAIDS and the Stop TB Partnership have a long-standing collaboration working together to advocate for, monitor and support programmes for people and countries affected by the joint global TB and HIV epidemics. The Stop TB Partnership Board provides leadership and direction, monitors the implementation of agreed policies, plans and activities of the partnership and ensures smooth coordination among Stop TB Partnership components.

A global ministerial conference held in Moscow, Russian Federation, on 16 and 17 November that united more than 1000 participants, including 75 ministers and 114 country delegations, concluded with the adoption of the Moscow Declaration to End TB.

The Moscow Declaration to End TB is a new commitment to increase multisectoral action and enhance accountability in the global TB response towards ending tuberculosis (TB) by 2030. The declaration will also inform the first United Nations General Assembly High-Level Meeting on TB, in 2018, which will seek to advance commitments to end TB from heads of state and government.

The declaration outlines the importance of international action to address key areas to respond to TB: sustainable financing, pursuing science, research and development and the establishment of a multisectoral accountability framework.

The conference, the First World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: a Multisectoral Response, was opened by the President of the Russian Federation, Vladimir Putin. It was attended by high-level United Nations leaders, including Amina J. Mohammed, the United Nations Deputy Secretary-General, Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, and Michel Sidibé, the UNAIDS Executive Director.

TB is the world’s leading cause of death from infectious disease—in 2016, 1.7 million people died from the disease—and has profound economic and social consequences. The public health crisis of multidrug-resistant TB continues to deteriorate and TB is the leading cause of death among people living with HIV. 

During the conference, Mariam Avanesova, who was treated for multidrug-resistant TB in Armenia from 2010 to 2012 and represents the organization TBpeople, the Eurasian network of people living with TB, handed over the #StepUpforTB petition. The petition is an urgent call for health ministers in key TB-affected countries to ensure that their TB policies and practices are in line with international standards, as defined by the World Health Organization, including testing and treatment of TB and its drug-resistant forms. Initiated by Médecins Sans Frontières and the Stop TB Partnership, the petition has been signed by more than 30 000 people from 120 countries.

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Global progress to End TB not fast enough to reach global TB and HIV targets

Tuberculosis (TB) retains its undesirable status as the leading infectious cause of death globally. According to the latest WHO Global Tuberculosis Report 2017 launched this week, global progress in reducing new tuberculosis (TB) cases and deaths is insufficient to meet the global targets for TB and HIV, despite most deaths being preventable with early diagnosis and appropriate treatment of tuberculosis and HIV.

As part of global efforts to advance the response to TB is now being pushed higher up the global development agenda with hundreds of global leaders attending the first WHO Global Ministerial Conference on Ending TB in Moscow from 14-17 November and a dedicated United Nations General Assembly High-Level Meeting on TB in 2018.

“We have an unprecedented opportunity to shine the political spotlight on the inequalities that drive the epidemics of TB and HIV,” said Michel Sidibé, UNAIDS Executive Director, “The return on investment in TB and HIV is more than just dollars, it's in voices heard, rights protected and lives saved.”

In 2016, the risk of developing TB disease among the 37 million people living with HIV was around 21 times higher than the risk in the rest of the world population. There were more than one million TB cases among people living with HIV—10% of all global TB cases in 2016. People living with HIV are much more likely to die from TB disease than HIV-negative people, and one in five (22%) TB deaths occurs among people living with HIV. In 2016, there were 374 000 TB deaths among people living with HIV, which represents almost 40% of all AIDS-related deaths.

TB disease and deaths can be avoided with TB preventive therapy but most people living with HIV who can benefit are not receiving it. In 2016, fewer than 1 million people newly enrolled in HIV care were started on TB preventive treatment. South Africa accounted for the largest share of the total (41%), followed by Mozambique, Zimbabwe and Malawi.

The global burden of drug-resistant tuberculosis continues to rise with an estimated 600,000 cases requiring treatment but only one in five were enrolled on treatment in 2016.

Global TB incidence is only falling at about 2% per year and 16% of TB cases die from the disease; by 2020, these figures need to improve to 4–5% per year and 10%, respectively, to reach the first (2020) milestones of the WHO End TB Strategy. Major gaps remain in global funding for TB prevention and treatment (US$2.3 billion) and TB research into new drugs, vaccines, and diagnostics (US$1.2 billion) for 2017.

In the past decade, there have been extraordinary leaps in medical technology that have the potential to save lives by dramatically improving the diagnosis and treatment of tuberculosis (TB) and HIV—two of the leading causes of death globally. More remarkable, perhaps, is the fact that these new tests and treatments are available and affordable in almost every country of the world through concerted global efforts to reduce prices.

However, there are millions of reasons why it is too early to celebrate success—the missing millions who are not being reached by HIV and TB services. UNAIDS estimates that in 2015 there were more than 18 million people living with HIV in need of access to life-saving medicines to treat HIV.

New tests have reduced the time to diagnose drug-resistant TB from two months to a matter of hours. Even when effective testing and treatment services for HIV and TB are available free of charge, though, the barriers to accessing them are insurmountable for many of the people who need them most.

“The missing millions are hidden among the world’s poorest, most marginalized populations, such as refugees, sex workers, prisoners, people who use drugs, migrants and people who move to cities in search of a better life and end up in informal settlements, left behind by health and social services,” said Michel Sidibé, Executive Director of UNAIDS. “Many barriers, including lack of transport, poor education, stigma and discrimination, criminalization and food insecurity, prevent them benefiting from the effective tests and medicines that are freely available today, far less the new technologies of tomorrow.”

UNAIDS, the World Health Organization and other global technical partners and donors are discussing how to overcome these barriers to reaching the missing millions at the Stop TB Partnership board meeting, taking place in Berlin, Germany, on 17 and 18 May.

“Our current problem is not the lack of effective tools, policies and guidelines to treat and prevent tuberculosis and HIV, it is how to turn policies into actions. We need the implementation part: concrete actions to be put in place and scaled up to save the lives of millions of people and guarantee an end to the global epidemics of tuberculosis and HIV,” said Lucica Ditiu, Executive Director of the Stop TB Partnership.

Our window of opportunity to end the global epidemics of AIDS and TB is shrinking. Health and development priorities are shifting and complacency is setting in. Our global failure to reach the people most in need with the basic services they need to prevent, diagnose and treat TB and HIV enhances the development of drug resistance, which could render TB and HIV untreatable.

UNAIDS is working with partners to reduce TB-related deaths among people living with HIV by 75% by 2020, as outlined in the World Health Organization End TB Strategy, as well as the targets set in the Stop TB Partnership’s Global Plan to End TB 2016–2020, to achieve the 90–90–90 targets to reach 90% of all people who need TB treatment, including 90% of populations at high risk, and achieve at least 90% treatment success, including through expanding efforts to combat TB, including drug-resistant TB. 

GENEVA, 24 March 2017—On World Tuberculosis Day, 24 March, UNAIDS is urging countries to do much more to reduce the number of tuberculosis (TB) deaths among people living with HIV. TB is the most common cause of hospital admission and death among people living with HIV. In 2015, 1.1 million people died from an AIDS-related illness—around 400 000 of whom died from TB, including 40 000 children.

“It is unacceptable that so many people living with HIV die from tuberculosis, and that most are undiagnosed or untreated,” said Michel Sidibé, Executive Director of UNAIDS. “Only by stepping up collaboration between HIV and tuberculosis programmes to accelerate joint action can the world reach its critical HIV and tuberculosis targets.”

Eight countries—the Democratic Republic of the Congo, India, Indonesia, Mozambique, Nigeria, South Africa, the United Republic of Tanzania and Zambia—account for around 70% of all TB deaths among people living with HIV. Scaling up action in these eight countries would put the world on track to reach the ambitious target in the 2016 United Nations Political Declaration on Ending AIDS of reducing TB-related deaths among people living with HIV by 75% by 2020.

Weaknesses in health systems are continuing to result in missed opportunities to diagnose TB among people living with HIV—around 57% of HIV-associated TB cases remained untreated in 2015. Inadequate linkages to care after diagnosis, poor tracking of people and loss to follow-up, failure to reach the people most at risk of disease—particularly marginalized populations, including people who inject drugs, prisoners and migrant workers—and poor treatment outcomes contribute to the lack of progress. In 2014, around 11% of HIV-positive TB patients died, compared with 3% of HIV-negative TB patients. Early detection and effective treatment are essential to prevent TB-associated deaths, especially among people living with HIV.

Drug resistance is also a major concern—in 2015, there were an estimated 480 000 new cases of multidrug-resistant TB. The recent approval of two new medicines to treat TB, the first in more than 60 years, is improving the outlook for people with drug-resistant TB.

UNAIDS calls for the elimination of TB deaths among people living with HIV and for health systems to be strengthened and services integrated to allow for a more rapid scale-up of HIV and TB programming. Countries must expand HIV prevention and treatment programmes that include regular TB screening, preventive therapy and early treatment, since they are simple, affordable and effective programmes that prevent TB deaths.

UNAIDS is continuing to support countries to Fast-Track their efforts to reach the critical 2020 targets of the 2016 Political Declaration. As part of these efforts, UNAIDS is urging countries to intensify action in 35 high-priority countries to accelerate results by implementing focused, high-impact programmes to advance progress in ending the AIDS epidemic.

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.

Ministries of Health from eastern Europe and central Asia adopted on 3 November in Minsk, Belarus, a consensus statement on HIV and tuberculosis (TB) treatment for all, calling for expanded and rapidly scaled-up access to affordable, quality-assured medicines.

Representatives of Ministries of Health of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan endorsed the statement at the conclusion of a two-day regional consultation.

Governments committed to strengthen regional cooperation in order to advance access to affordable and quality medicines and deliver more cost-effective, equitable and sustainable solutions for common challenges by intensifying efforts through regional solidarity, shared responsibility and political leadership.

The statement underlines that countries are ready to use all available tools to reduce the price of life-saving medicines, address intellectual property issues and their alignment with national legislation, support the local manufacturing of medicines and optimize medicine regimens in line with World Health Organization (WHO) recommendations.

More than 160 participants, including representatives of ministries of health, national experts, representatives of the pharmaceutical industry and partners from international organizations and civil society, participated in the regional consultation.

Eastern Europe and central Asia is home to the fastest growing HIV epidemic and the highest levels of multidrug-resistant TB in the world. Expanding antiretroviral therapy eligibility based on the WHO recommendations to treat people who test positive for HIV as soon as possible is expected to have significant cost implications for the HIV response in all countries of the region.

The event was hosted by the Ministry of Health of Belarus with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS and the Stop TB Partnership.

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In the 2016 report on the state of the global tuberculosis (TB) epidemic and response, the World Health Organization announced that there were an estimated 10.4 million new TB cases in 2015, higher than previous estimates. However, only 6.1 million TB cases were detected and officially reported in 2015, demonstrating a major gap in finding and testing people who may have TB. Six countries accounted for 60% of the total global burden of TB—China, India, Indonesia, Nigeria, Pakistan and South Africa. Tuberculosis remains a leading cause of death among people living with HIV, despite being curable at low cost. The cost of not treating TB, however, is high in terms of disease spread and death.

In 2015, an estimated 1.8 million people died from TB—of these deaths, 0.4 million occurred among people who were also HIV-positive. More than 20% of people living with HIV and TB disease were not receiving life-saving antiretroviral medicines, a missed opportunity to deliver comprehensive and integrated care and treatment. TB can also be prevented among people living with HIV with early antiretroviral treatment and isoniazid preventive therapy, but uptake of preventive therapy remains inadequate.

A particularly worrying finding from the report is the inadequate response to the rising burden of multi-drug resistant (MDR) TB. Only one in five people who are eligible received treatment for MDR TB in 2015. Furthermore, the cure rate for MDR TB remains disappointingly low, at 52% globally, despite recent improvements in access to new treatments.

Increasing drug resistance is one of the greatest threats to reducing the burden of illness and deaths from infectious diseases, such as HIV, TB and malaria, that prevent many people living in low- and middle-income countries from achieving their full potential. Urgent action is needed to prevent the development and spread of drug resistance, and investment in research to find new therapies to replace those rendered ineffective through drug resistance is critical.

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