Health systems leave behind nearly half of all people with TB-HIV

By Mandy Slutsker, Policy and Advocacy Manager, ACTION

As we commemorate World AIDS Day — an opportunity to unite as a global community in the fight against HIV and AIDS — I’m reminded of Nelson Mandela’s remarks at the 2004 International AIDS Conference in Bangkok about tuberculosis (TB):

“We are all here because of our commitment to fighting AIDS. But we cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS.”

This statement still rings true today, as TB causes one-third of all AIDS-related deaths, remaining the leading killer of people with HIV. Though there are many causes, the foremost reasons are that TB preys on weak immune systems, like those of people with HIV, who are 20 times more likely to develop active TB than people without HIV.

Yet, there is one primary reason that TB remains a leading killer of people with HIV: health systems are leaving behind nearly HALF of all people with TB-HIV.

In 2017, the World Health Organization (WHO) estimated that there were 920,000 people with HIV who became sick with TB. However, half of these people were “missing,” meaning they were not diagnosed and/or reported to the WHO. That’s 455,367 people where the quality of care — if there was care at all — is simply unknown.

TB and HIV are known as the “deadly duo” because each epidemic heightens the risk, intensifies the damage, and thwarts efforts to end the other. If we are to have a world truly free of HIV, we also must work to eliminate TB, and that starts with diagnosing and treating everyone with TB-HIV.

To ensure no one is left behind, governments, civil society, affected communities, and the private sector must work with global donors. Together, they must…

  • invest in training, paying, and supporting community health workers to find and treat people with TB and HIV. By providing home visits to people with TB and HIV, community health workers can improve TB screening, HIV testing, treatment coverage, and access to preventive therapy.
  • engage civil society and affected communities to raise awareness about TB and HIV and bridge the gap between hard-to-reach groups and health providers.
  • integrate TB and HIV screening into people’s first point of healthcare. In places with high rates of TB and HIV, people should be screened for TB at all primary health settings. Additionally, people living with HIV should be screened for TB when they go for routine checkups.
  • invest in appropriate tools and diagnostics for people with TB and HIV. Countries should invest in the latest TB diagnostic tool, GeneXpert, as well as tests that are able to detect TB in people living with HIV such as the LAM urine test.
  • harness the reach of the private sector so that people receive appropriate care regardless of where they seek it.
  • increase funding for national TB and HIV programs. Policies cannot be effectively implemented without funding!