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World AIDS Day 2016: Progress on AIDS could be derailed by TB

On this World AIDS Day (December 1), Australians have reason to be optimistic about the progress made both here and globally over the last 30 years towards ending the AIDS epidemic as a public health threat. However in the midst of this optimism, the sad fact is that tuberculosis (TB) could derail much of this progress. As one of the oldest illnesses known to man, TB has overtaken HIV and is once again the world’s leading infectious-disease. But more importantly TB is also the greatest global killer of people living with HIV with one in three deaths among people living with HIV due to TB.

“These two epidemics fuel each other in a potentially deadly duo of coinfection. People with low immunity such as those living with HIV are more susceptible to developing TB which if left undiagnosed accelerates the progression of HIV. Similarly, untreated HIV can increase the risk of developing, fuelling and spreading active TB.  Both diseases therefore need to be diagnosed and treated together if we’re to continue our advances in the control of HIV, “explains Maree Nutt CEO of global health advocacy organisation, RESULTS Australia.

While countries burdened with these diseases are moving in the right direction, not all of their policy changes have translated into improvements for patients. National TB and HIV programmes remain largely separate, meaning less efficient procurement of TB drugs, a lack of information to health facilities and unco-ordinated scheduling of services for people receiving treatment for TB and HIV.  In addition, most of the burden of supporting key TB-HIV activities still falls heavily on TB programmes, which are under-resourced.

“The World Health Organisation has identified six countries in our region (China, India, Indonesia, Myanmar, PNG, and Thailand) as having heavy burdens of both HIV and TB.  What we are seeing increasingly is that countries themselves are covering the costs of testing and treatment for TB, whilst donor funding, which is largely aimed at the HIV response, caps contributions towards TB. The planning, coordination and resource allocation for TB and HIV responses needs to be more equitably shared between these sectors of health.

“You can’t treat people living with HIV without also addressing TB and any funding cuts to one disease risks derailing progress on both, which is something we can’t afford to risk.”

The situation in Indonesia – which has 10% of the world’s TB burden – is a good example. The country’s Ministry of Health has recently renewed its joint focus on TB-HIV coinfection, with efforts to improve co-ordination, service delivery and reporting. Through active case-finding the national TB programme calculated that it had failed to reach 680 000 people with the disease. Although 6 percent of new TB cases in Indonesia are among people living with HIV, these individuals might otherwise have died from a treatable illness due to the lack of TB-HIV service integration across public and private health care. Making services available in the same facility would mean being able to test people for TB when they come in to receive HIV antiretroviral treatments.

What does the scale of the TB-HIV coinfection in our region mean for Australia and how might we respond? Australia is the largest contributor of aid to Papua New Guinea, which has among the highest incidences of TB in the world (30 000 people in a population of 7.5 million are newly infected each year) and a specific problem with drug-resistant strains of the disease.

“We need to ensure that this aid is not compromised if we wish to see progress maintained in the fight against both of these diseases.”

“Civil-society advocates, policy-makers and academics who work directly on TB are well aware of its deadly connection with HIV, but this link needs to be better appreciated by the wider community including governments, donors and those working on HIV-related issues everywhere. It is unconscionable that people might increasingly live with HIV, but die of TB: there will be no ‘end to AIDS’ globally without an end to TB,” Ms Nutt concluded.


For more information on HIV and Global Tuberculosis Report 2016.


Media Contact: Monique McDonell, Media and Communications Manager at RESULTS Australia