Globally, in 2015, an estimated 36.7 million people were living with human immunodeficiency virus (HIV); of these, 17.8 million were women over 15 years of age. About 2.1 million people were newly infected with HIV in 2015. 46% of people living with HIV/AIDS (PLHIV) were receiving antiretroviral treatment. AIDS lead to1.1 million deaths in 2015 including 110 000 children (less than 15 years of age). In the SEAR countries, there are an estimated 3.5 million living with HIV/AIDS and approximately 230 000 new infe ctions are added to the pool annually.
In 2015, an estimated 1.2 million (11%) of the 10.4 million people who developed tuberculosis (TB) worldwide were HIV positive. Globally, the number of people dying from HIV-associated TB peaked at 570 000 in 2004 and had fallen to 390 000 in
2015 (32% decrease). In SEAR, an estimated 74 000 people died of HIV-associated
TB in 2015.
The SEA Region of WHO is home to 26% of the world’s population; however, the Region accounts for 45.6% of the global burden in terms of TB incidence. In 2015, there were an estimated 4.7 million incidence cases of TB, and about 710 000 people died due to TB in the SEA Region. In addition, an estimated 227 000 cases (4.7%) of the 4.7 million incident cases in the Region were HIV positive. This corresponds to an incidence of HIV co-infected TB cases of about 12 per 100 000 population. An estimated 406 000 children in the Region developed TB in 2015.
Globally, 54% of notified TB patients had a documented HIV test result in 2015. Among HIV-positive TB patients notified globally in 2015, 78% were on ART.
People living with HIV are 29 times (26–31) more likely to develop tuberculosis (TB) disease compared with people without HIV and living in the same country. TB is a leading cause of hospitalization and death among adults and children living with HIV, accounting for one in five HIV-related deaths globally.
1.1 WHO response to TB-HIV
End TB Strategy: In 2014, the World Health Assembly approved the new strategy to end TB. This Strategy includes (1) bold vision of a world without tuberculosis, and its targets of ending the global tuberculosis epidemic by 2035 with a reduction in tuberculosis deaths by 95% and in tuberculosis incidence by 90%, and elimination of associated catastrophic costs for tuberculosis-affected households; (2) its associated milestones for 2020, 2025 and 2030; (3) its principles addressing: government stewardship and accountability; coalition-building with affected communities and civil society; equity, human rights and ethics; and adaptation to fit the needs of each epidemiological, socioeconomic and health system context.
The strategy is based on three pillars: (1) integrated, patient-centred care and prevention; (2) bold policies and supportive systems; and (3) intensified research and innovation.
Global Plan to End TB: The Global Plan provides an opportunity for greater alignment among efforts to fight both diseases. Taking inspiration from the UNAIDS target of providing treatment to 90% of people who know their HIV-positive status, the Global Plan calls for countries to find at least 90% of all people with TB in the population that require treatment (including those living with HIV) and place them on appropriate therapy (including TB treatment and preventive therapy for people living with HIV).
Reaching these targets will require an accelerated integration of TB and HIV services, as well as strong leadership and political commitment. There also need to be separate but interconnected approaches to address HIV infection in people with TB and to reduce the risk of TB in people living with HIV, in line with the interventions recommended by WHO and UNAIDS for jointly addressing HIV and TB.
This Global Plan provides detailed investment scenarios needed to accelerate collaborative efforts to address TB-HIV co-infection in different settings.
Global Health Sector Strategy on HIV 2016–2021 maps the way forward along five strategic directions:
using accurate strategic information to understand HIV epidemics and focus responses;
defining the essential packages of high-impact HIV interventions along the continuum of HIV services;
effectively delivering the cascade of HIV services to different populations and locations to achieve equity, maximize impact and ensure quality;
implementing sustainable funding models for HIV responses and reducing costs; and
innovating new HIV technologies and ways of organizing and delivering services.
Ending TB in the South-East Asia Region: Regional Strategic Plan 2016–2020: the guiding principle of the regional strategy is laid on the bedrock of government stewardship; TB prevention, care and control as part of health system strengthening based on primary health care; fostering partnerships at all levels; and promoting ethical values and human rights principles.
1.2 Global response plan
Between 2005 and 2014, an estimated 5.8 million lives were saved by TB-HIV interventions.
WHO has provided clear recommendations about the interventions needed to prevent, diagnose and treat TB among PLHIV since 2004, collectively known as collaborative TB-HIV activities. They include: establishing mechanisms for collaboration between HIV and TB programmes (joint planning, coordinating bodies, surveillance, and monitoring and evaluation); reducing the HIV burden among TB patients (HIV testing and counselling, provision of ART and CPT to TB patients living with HIV, and HIV prevention, care and support services for TB patients); reducing the burden of TB among PLHIV with the “Three I’s for HIV/TB” (intensified TB case- finding among PLHIV, isoniazid preventive therapy for PLHIV who do not have active TB, and infection control in health care and congregate settings). Variable progress has been made towards these goals in countries of the South-East Asia Region.
1.3 Progress made
Integration of HIV and tuberculosis services reduced the annual number of people dying from HIV-associated TB globally from 500 000 [460 000–530 000] in 2000
to 390 000 [350 000–430 000] – a 22% decline in 2014. During this period, 5.9 million lives were saved in Africa.
By 2014, 17 of the 41 countries with the highest burden of HIV and TB co- infection are estimated to have met the target of reducing the number of people dying from HIV-associated TB by at least 50%. This is the result mainly of important improvements in the reach, quality and linking of HIV and TB services. Despite these achievements, TB remains a leading cause of HIV-associated hospitalization and death among people living with HIV worldwide. TB accounted for 31% of the estimated 1.4 million HIV-related deaths globally in 2015.
Globally, 55% of notified TB patients had a documented HIV test result in 2015. This represented an 18-fold increase in testing coverage since 2004. The figure was highest in the African Region, at 81%, and the Americas at 82%. In 2014, coverage of antiretroviral therapy (ART) for notified TB patients who were known to be co- infected with HIV reached 78% globally. Further efforts are needed to reach the target of 100%. This is especially the case given that the number of HIV-positive TB
4. patients on ART in 2014 represented only 33% of the estimated number of people living with HIV who developed TB in 2014.
Coverage of co-trimoxazole preventive therapy (CPT) among HIV-positive TB patients remains high, and increased slightly to 87% globally and 89% in the African Region in 2014. The number of people living with HIV who were treated with isoniazid preventive therapy (IPT) reached 933 000 in 2014, an increase of about 60% compared with 2013. However, provision of IPT was reported by just 23% of countries globally, including only 13 of the 30 high TB-HIV burden countries. As in previous years, a large proportion of the people living with HIV who were initiated on IPT were in South Africa (59%), although in most countries that reported data in 2013 and 2014, coverage levels grew.
The rate of mother-to-child transmission of HIV has been cut by more than half between 2000 and 2014. Mother-to-child transmission has been eliminated in Thailand.
Source: WHO SEARO