Globally, the number of people living with HIV who have died from tuberculosis (TB), a curable and preventable disease, has dropped from nearly 600,000 deaths in 2010 to just over 200,000 in 2019, a drop of 63%. In 2016, the United Nations set a global goal of reducing TB mortality among people living with HIV by 75% between 2010 and 2020. Nine countries (Djibouti, Eritrea, Ethiopia, India, Malawi, South Africa, Sudan, Thailand and Togo) achieved or exceeded the global target by the end of 2019, one year ahead of schedule.
Further progress towards global goals has been made to make preventive TB treatment more accessible to people living with HIV. Preventive TB treatment greatly reduces the risk of getting TB. In just two years — in 2018 and 2019, 5.3 million people living with HIV received life-saving preventive TB treatment. That is already 88% of the target of 6 million set for 2022 in the United Nations Political Declaration on the Abolition of TB for 2018.
While progress in some countries is commendable, these successes mask a number of inequalities and gaps that remain in providing the best integrated care for people living with HIV and TB. These gaps resulted in an estimated 208,000 preventable TB-related deaths in 2019 – roughly one in three AIDS-related deaths.
“One of the biggest differences in the global response to HIV and TB is reaching children,” said Shannon Hader, UNAIDS Deputy Executive Director for the program. “Much better tools for the prevention, diagnosis and treatment of TB and drug-resistant TB for young children are now available, but still not enough. Too many children have not yet reached these new tools. Some health professionals lack confidence to manage TB among children who they live with HIV, and for fear of harm and a desire to protect themselves, children do not always act. Children are “protected to death.” We need to build confidence to manage TB and HIV in young children and achieve transformation goals. “
TB is especially difficult to diagnose in the youngest infants and children living with HIV – those younger than two years. The most severe forms of TB — disseminated TB and TB meningitis — are common among this age group and are life-threatening without prompt diagnosis and treatment. Much progress has been made in improving the diagnosis of TB in children. Child-friendly medicines for the treatment and prevention of TB are available at a low price by the Global Stop TB Fund. The challenge of this innovation is to adapt to the scale and quality needed to reach all children living with HIV in need.
The Rome Pediatric Action Plan on HIV and TB, part of UNAIDS and the United States President’s AIDS Emergency Plan, closes the gaps for children living with HIV. It is a unique multi-stakeholder partnership that has fostered unprecedented collaboration among the religious community, the private sector, regulators, donors and others to accelerate the development and implementation of better diagnostic tests, preventive measures and treatment for HIV and TB among children living with HIV. -om.
In 2019, less than half (49%) of the estimated 815,000 people living with HIV who also have TB were reported to have received both HIV and TB. This shows that large gaps remain in screening, testing, and treatment for both HIV and TB. To address this problem, national programs must go beyond traditional health facilities to find the missing millions of people who still need treatment for HIV, TB, or both. An integrated approach based on the community and people is needed. Multidimensional family and community screening for TB, HIV, COVID-19, high blood pressure, diabetes, and other common conditions can de-stigmatize and can reduce costs for programs and people. It is crucial to encourage all people who have recently been diagnosed with HIV, TB or COVID-19 to provide a confidential examination of their families, households and community contacts, including children and young people.
The clock is already ticking to reach the ambitious new goals for TB and HIV by 2025 set in the new global AIDS strategy for 2021-2026. Achieving these goals will put the world back on track to stop AIDS and TB by 2030. A common and integrated response to the TB, HIV and COVID-19 pandemics is needed. The response must be rooted in the affected communities and focused on the needs of the most vulnerable people. Addressing the inequalities triggered by TB and HIV will help close the “deadly divide” between global commitments and the lived reality of TB and HIV-affected communities. By ending inequality, we can stop the deaths of adults, young people and children living with HIV from TB.