Tuberculosis and HIV/AIDS


March 21, 2014

Overview

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH). Globally, an estimated 13% of TB cases are co-infected with HIV and at least one-third of the nearly 36 million PLWH are infected with the bacterium that causes TB. According to the Stop TB Partnership, more than 1,000 people infected with HIV die every day from tuberculosis. The dual epidemic is particularly pervasive in sub-Saharan Africa, where 80% of the total global burden of dual HIV/TB cases is found.

Ending HIV-associated TB among PLWH is possible through a combination of widespread ART coverage, early identification and treatment of TB, isoniazid preventive therapy, and infection control activities. These high-impact interventions will be critical to achieving an AIDS-free generation and are integral to PEPFAR planning and program implementation.

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Saving Lives with Smarter Programs

PEPFAR supports programs to integrate the prevention, diagnosis, and treatment of TB into HIV services. In turn, PEPFAR supports programs to integrate HIV prevention, testing, care and treatment into TB services. PEPFAR’s important role in Health Systems Strengthening also contributes to reducing the impacts of TB and HIV co-infection.

Routine HIV testing for people with TB

  • Routine HIV testing for people with TB, their partners and families, and people with symptoms of TB.
  • TB screening in HIV care and treatment services, and referral of anyone with symptoms of TB for further diagnostic evaluation and timely initiation of treatment.

Treatment and Services

  • Early initiation of antiretroviral therapy (ART) in HIV-infected people with active TB.
  • Provision of isoniazid prophylactic treatment to prevent TB in co-infected persons.
  • Provision to PLWH of co-trimoxazole, a cost-effective medicine to prevent against opportunistic infections.
  • Referrals to ongoing HIV care and treatment for people with TB who test positive for HIV.
     

Health Systems Strengthening

  • Development of a TB infection control training and implementation package to help reduce TB transmission in healthcare facilities.
  • Development of a comprehensive curriculum and training materials, as well as HIV/TB surveillance that can be adapted by national TB and HIV programs.
  • Laboratory infrastructure for timely and accurate diagnosis of TB through strengthening of sputum microscopy, chest radiography, and a continued phased rollout of GeneXpert, a new rapid molecular test for TB and drug resistance. To date, more than 250 GeneXpert instruments have been procured and deployed in countries where PEPFAR works.

By the Numbers

  • In 2013, PEPFAR-supported programs contributed to the screening of more than 5.9 million PLWH for TB in HIV care or treatment settings and acceleration of TB treatment initiation for more than 219,000 patients in HIV care.
  • PEPFAR-supported programs have also contributed to increased rates of HIV testing among TB patients. In sub-Saharan Africa, the percentage of TB patients who know their HIV status rose from 69% in 2011 to 74% in 2012.
  • From 2005 to 2011, through collaborative TB/HIV interventions, PEPFAR-supported programs contributed to 1.3 million lives saved.

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