Stop TB Partnership

Tuberculosis (TB) remains a leading cause of death among people living with HIV. In 2013, 360 000 HIV-positive people around the globe died of TB, a disease which is both preventable and curable. Greater commitment and resources are needed to mount an effective response to TB and a high-level round-table event examined how this can be done through the new funding model of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

The event, which took place in Barcelona, Spain, on 30 October, provided an opportunity to exchange country experiences and information on TB financing and investing for impact. Participants also discussed the challenges and opportunities emerging from the new funding model, which promotes more strategic, flexible and predictable investment. 

On the opening panel, Global Fund Executive Director Mark Dybul was joined by South Africa’s Minister of Health, Aaron Motsoaledi, Blessi Kumar of the Global Coalition of TB Activists, USAID TB Senior Policy and Strategy Advisor Amy Bloom and UNAIDS Executive Director Michel Sidibé.

The panellists highlighted the importance of social movements and community engagement for more sustainable and inclusive approaches. They recognized the need for additional resources and called for more focused use of existing resources. It was also stressed that approaches to TB and HIV must be people-centred rather than disease-centred.

GENEVA, 24 March 2014—On World Tuberculosis (TB) Day, UNAIDS is making an urgent call for global efforts to be stepped up to ensure earlier testing and treatment of TB and HIV. TB remains a leading cause of death among people living with HIV. In 2012, there were an estimated 1.1 million new cases of TB among people living with HIV—with 75% of new cases occurring among people living in Africa.

The dual impact of TB and HIV is devastating for millions of people and their families. This is unacceptable as TB is both preventable and curable. By expanding access to basic TB prevention for people living with HIV, the target of reducing TB deaths in people living with HIV by 50% can be reached by 2015.

Scientific studies have shown that early HIV diagnosis and access to treatment for HIV can reduce a person’s risk of TB by 65%. When treatment of TB is combined with ART, the risk of TB disease can be reduced by around 90%.

People in high-burden settings should have the opportunity to learn their HIV status and start treatment early in order to prevent active TB disease. If people living with HIV develop active TB disease then immediate ART can reduce their chance of dying by around 50%. Unfortunately, despite what is known about the importance of early diagnosis and treatment of both HIV and TB, millions of people often discover too late that they have HIV and TB.

UNAIDS launched Treatment 2015 to expand access to HIV treatment, which is important to both HIV and TB prevention efforts. UNAIDS is calling for an innovative, integrated effort to prevent HIV and TB—working together to increase resources and reach everyone living with HIV with key TB prevention interventions, including earlier access to HIV and TB testing and treatment.

UNAIDS is working closely with countries, donors and partners, including the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States President’s Emergency Plan for AIDS Relief, to produce sustainable solutions to fully integrate and deliver critical HIV and TB services.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

L to R: UNAIDS Executive Director, Michel Sidibé and Dr Barnabas Sibusiso Dlamini, Prime Minister of Swaziland.
Credit: UNAIDS/J.Matas

Despite being one of the smallest countries in Africa, Swaziland has the highest percentage of people living with HIV anywhere in the world. More than a quarter of its adult population are living with the virus. Yet the people of Swaziland are facing not just one, but two deadly epidemics which intertwined are wreaking havoc throughout not only Swaziland but the whole of the sub-Saharan African region. Those epidemics are tuberculosis (TB) and HIV.

More than three-quarters of people who have TB in Swaziland are also living with HIV and an estimated 16 000 Swazis develop life-threatening, active TB disease every year. The combination of the two epidemics has made TB the leading cause of death in people living with HIV as the TB bacteria accelerates the progression of HIV infection to AIDS, weakening the body’s immune system until it can no longer fight disease.

But Swaziland is also determined to stop the epidemics in their tracks.

This week Swaziland played host to a powerful delegation of health leaders and experts committed to ending the dual epidemics of TB and HIV across the region. Convened by the Ministers of Health of both Swaziland and South Africa, supported by the Stop TB Partnership the meeting brought together brilliant minds and solid expertise to find ways of accelerating action to end the TB and TB/HIV co-epidemics in the countries of the Southern Africa Development Community (SADC).

“This is our last chance to put Africa back on track to achieve TB and HIV related targets,” said Dr Sibusiso Dlamini, Prime Minister of Swaziland stressing that progress towards the goal of reducing TB deaths in people living with HIV by 50% by 2015, set in the 2011 United Nations General Assembly Political Declaration on HIV and AIDS, was not moving fast enough.

Recognizing the importance of the challenge, Aaron Motsoaledi, Minister of Health of South Africa spurred participants to action, “You don’t set out to climb Everest expecting to fail,” he said. “We must set out expecting to succeed, no matter the size of the challenge ahead. Olympic athletes often come from far behind to win the race, we can do the same.”

The Everest he was referring to was the strong declaration of commitment which came out of the meeting––the ‘Swaziland Statement’. The statement highlights the determination of each of the partners to significantly cut TB/HIV related deaths over the next 1000 days and reach the 2015 goals.

“We need to lift up our expectations and raise our financial and technical contributions to realise the commitments we made to reduce the impacts of TB,” said Dr Lucica Dittu, Executive Secretary of the Stop TB Partnership.

Important commitments outlined in the statement include the full integration of TB and HIV services, new partnerships with non-traditional partners, a reinforcement of programmes and services and new and innovative methods of financing the response to the two diseases.

“A thousand people living with HIV die every day of TB on the African continent, this is unacceptable,” said UNAIDS Executive Director Michel Sidibé. “This initiative brings momentum, commitment and renewed energy which will produce results and improve the lives of millions of people across the region.”

UNAIDS pledged to continue working closely with its partners including the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure that everyone living with both HIV and active TB is able to start HIV treatment; that everyone in TB care is offered an HIV test; and that everyone in HIV care is offered screening for TB.  

UNAIDS Executive Director Michel Sidibé joined health leaders from Africa and other international organizations to support a new push to accelerate progress against tuberculosis and HIV. The initiative was unveiled at a press briefing in Johannesburg, South Africa on 20 March and will be formerly launched on 21 March in Mbabane, Swaziland.

The initiative includes a package of new investments worth more than US $120 million which will be used to expedite progress against TB and HIV in the next 1000 days. The initiatvie will work with South African Development Community (SADC) countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015.

Mr Sidibé and other health leaders will sign the Swaziland Statement in Mbabane at tomorrow’s formal launch of the initiative.

Most TB/HIV deaths can be averted if TB and HIV services work together more effectively and services are scaled up

GENEVA, 27 November 2012––Last week the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that there has been a 13% reduction in tuberculosis (TB)-associated HIV deaths in the last two years. The reduction is due to a sharp increase in the numbers of people with HIV and TB co-infection accessing antiretroviral therapy (ART)––a 45% increase between 2009 and 2011.

Yet TB remains the leading cause of death among people living with HIV. UNAIDS and the Stop TB Partnership have signed a new agreement to accelerate action to achieve the 2015 goal of reducing deaths from TB among people living with HIV by 50%. 

“We are losing precious lives to TB––which is a preventable and curable disease, and it is in our power to change this. The world will never reach its goal of an AIDS-free generation without tackling TB. It is time to act now,” said Benedict Xaba, Minister of Health of Swaziland, which has the world’s highest rate of TB among people living with HIV.

People living with HIV are 20 to 30 times more likely to develop active TB than people without HIV infection.  An estimated 8.7 million people became ill with TB worldwide in 2011, among whom more than 1 million were living with HIV. Pregnant women and children are particularly at risk. If a pregnant woman living with HIV also has TB disease, the risk of death for the mother and child is higher and the risk of HIV transmission to the child more than doubles. In 2011, 430 000 out of 1.7 million AIDS-related deaths (25%) were caused by HIV-associated TB disease.

“TB/HIV is a deadly combination.  We can stop people from dying of HIV/TB co-infection through integration and simplification of HIV and TB services”, said Michel Sidibé, Executive Director of UNAIDS. “The 2015 goals are clear­­­­—reduce TB deaths in people living with HIV by 50%––we can make this happen, but only if services are scaled up in countries through concerted and joint efforts.”

In 2011, at the United Nations High Level Meeting on AIDS, UN Member States set the target of halving TB/HIV deaths by 2015, which would lead to saving 600 000 lives. Three-quarters of TB/HIV deaths currently occur in just ten countries;  Ethiopia, India, Kenya, Mozambique, Nigeria, South Africa, the United Republic of Tanzania, Uganda, Zambia and Zimbabwe. Intensifying efforts in these 10 countries would significantly accelerate progress in achieving the 2015 goal.

“TB is preventable and curable at low cost, yet we still have one in four AIDS-related deaths caused by TB, and this is outrageous. Countries have yet to fully implement the actions needed to address the co-epidemic,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “Through a new agreement UNAIDS and the Stop TB Partnership have committed to a strong agenda of action, engaging new partners and assisting the most heavily affected countries as they integrate their HIV and TB services and build action plans.”

Preventing HIV/TB deaths

• In countries where HIV and TB are prevalent, testing for both should be provided to everyone.
• People living with HIV are far less likely to become ill with and die of TB if they begin antiretroviral therapy (ART) before their immune systems begin serious decline. All people who are eligible for ART should receive it as early as possible.
• In addition to earlier ART, people living with HIV should be protected against becoming ill with TB through a daily dose of the drug isoniazid.
• All people who test positive for HIV and are also found to have TB disease should start TB treatment immediately. After two weeks on TB treatment, they should begin ART, regardless of the status of their immune system.

The Stop TB partnership has launched a Global Plan to Stop TB (2011-2015) aimed at halving tuberculosis (TB) prevalence and death rates by 2015 to reach the Millennium Development Goal of halting and beginning to reverse the epidemic by 2015.

The Plan, launched in South Africa, identifies research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to the market. It also shows how public health programmes can modernise diagnostic laboratories and adopt the new TB tests which have become available, replacing the century old diagnostic methods still used in many countries.

The Stop TB partnership are calling for US$ 37 billion to finance the plan from 2011-2015 which they estimate will allow them to diagnose and treat 32 million people over the next five years.

Without dramatic increases in funding and political commitment between 2010 and 2015 the Stop TB Partnership estimates that over 50 million people will develop active TB and that over 10 million lives will be lost to the disease which is both preventable and curable.

Every year around half a million people die from HIV-associated TB. If the plan's targets are met, by the end of 2015, all TB patients will be tested for HIV and, if the test is positive, receive anti-retroviral drugs and other appropriate HIV care. In HIV treatment settings, all patients will be screened for TB and receive appropriate preventive therapy or treatment as needed.

“Over a million people living with HIV fall ill with TB every year,” said Dr Paul De Lay, Deputy Executive Director, Programme, UNAIDS. “We need to make sure that all people living with HIV who need it, receive antiretroviral therapy, and that all people living with HIV are screened for TB every time they see a health care worker. This will help us to prevent diagnose and treat TB early and effectively in people living with HIV and avoid unnecessary deaths.”

In July this year the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Stop TB Partnership signed a memorandum of understanding to combine efforts to halve the number of people living with HIV who die from TB by 2015, compared to 2004 levels. The memorandum also outlines the importance of providing life-saving antiretroviral treatment for all TB patients living with HIV.

The Global Plan to Stop TB was launched by the South African Minister of Health, Dr Aaron Motsoaledi at a press conference held in the Pholosho Primary School in Alexandra which teaches more than 2000 children from the region.

Following the launch speakers from the press conference, together with children from the school, participated in a football tournament as part of the Kick TB Campaign. This is a campaign which seeks to combat TB as well as the stigma associated with it, by fusing sport and social mobilization to create a platform through which TB messages can be effectively conveyed.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. Credit: UNAIDS/P.Virot

The 18th Stop TB Partnership Coordinating Board meeting is being held from 4 – 5 May 2010 in Hanoi, Viet Nam. The meeting will bring together UNAIDS and the Stop TB Partnership to strengthen their joint response to HIV/TB co-infection and to agree on a compact intended to halve TB deaths in people living with HIV by 2015.

‘One in four AIDS deaths is linked to tuberculosis. This compact represents an important milestone in ensuring that no person living with HIV dies of TB, a preventable and curable condition’ noted UNAIDS Deputy Director, Programme Paul De Lay

Every three minutes a person living with HIV dies of tuberculosis. Mortality rates have escalated (to an estimated 500,000 a year) over the past 10 years. The emergence of drug resistant strains of TB is a particularly lethal threat in populations with high rates of HIV infection.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. UNAIDS hopes to achieve this goal by ensuring an effective integrated delivery of services for HIV and tuberculosis as well as nutritional support in all settings.

Universal access and MDG targets for HIV and TB will be difficult, if not impossible, to achieve without greater attention to marginalized and vulnerable groups, such as prisoners, drug users, women, and migrants, and the strengthening of a human rights approach to ensure equitable access and risk-reduction.

A wide variety of participants are expected to attend the meeting, including Ministers of Health of Viet Nam, South Africa and Myanmar, the Regional Director of the World Health Organization Western Pacific Region as well as high-level representatives from UNAIDS, the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Discussions will range from an overview of the TB epidemic in Viet Nam and the Western Pacific Region to a review of progress in the development of new TB drugs, diagnostics and vaccines.

The Board meeting is also meant to be a follow-up from the Beijing Ministerial Meeting held in April 2009 where ministers from countries with high burden of multi-drug-resistant tuberculosis (MDR-TB) and extremely drug-resistant tuberculosis (XDR-TB) met to address the disease’s alarming threat. The 18th Stop TB Partnership Coordinating Board meeting will review the progress made by countries since Beijing and recommend further actions to overcome bottlenecks and accelerate action.

The Stop TB Partnership is a leading public-private global health partnership, established in 2001, with the aim of eliminating tuberculosis as a public health problem and, ultimately, to obtain a world free of TB. It comprises a network of more than 900 international organizations, countries, donors from the public and private sectors, governmental and nongovernmental organizations and individuals.

Although it is mostly preventable and curable, tuberculosis (TB) is one of the leading causes of death among people living with HIV globally. Of the 33 million people who are living with HIV, only 20% of know their status, and only a tiny fraction, 2% in 2007, were screened for TB according to the World Health Organization’s annual report on global TB control launched today.

HIV is dramatically fuelling the TB epidemic in sub-Saharan Africa, where up to 80% of TB patients are co-infected with HIV according to the report. A respiratory infection that spreads like the common cold, TB exploits an immune system already weakened by HIV.

“We have to stop people living with HIV from dying of tuberculosis,” said Mr Michel Sidibe, Executive Director of UNAIDS. “Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives.”

Global Tuberculosis Control 2009 provides an up-to-date assessment of the TB epidemic and progress in controlling the disease. It notes that globally only 16% of TB patients know their HIV status and so the majority of HIV-positive TB patients do not know that they are living with HIV and are not accessing HIV treatment.

However, there has been progress in this area with increased HIV testing among people being treated for TB, especially in Africa. In 2004, just 4% of TB patients in the region were tested for HIV; in 2007 that number rose to 37%, and in some countries (Kenya, Lesotho, Malawi, Rwanda and Swaziland) over 70% of all TB patients know their HIV status.

Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need. In 2007, 200 000 HIV-positive TB patients were enrolled on co-trimoxazole treatment to prevent opportunistic infections and 100 000 were on antiretroviral therapy.

Need for integrated TB and HIV services

For many years efforts to tackle TB and HIV have been largely separate, despite the overlapping epidemiology. Improved collaboration between TB and HIV programmes will lead to more effective prevention and treatment of TB among people living with HIV and to significant public health gains.

The release of the report today coincides with World TB Day and a 1500-strong gathering at the 3rd Stop TB Partners’ Forum in Rio.

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22 July 2010 - Vienna, Austria - It's a story that unfolds every day around the world but is rarely heard. A woman, man or child living with HIV gets exposed to tuberculosis (TB) in a setting where there are no measures to stop the spread of infection. It could be a workplace, a prison, a clinic or even at home. Soon the person is sick - coughing, feverish and weak.

This story is being told and retold this week among the 20 000 participants gathered for the 2010 International AIDS Conference. It's a story that can end well if the person is lucky enough to have access to both antiretroviral and TB treatment. But too often there is a fatal finish. Without proper treatment about nine out of 10 people living with HIV who become ill with active TB will die within two to three months.

The dual epidemic has fanned across Africa, Asia and Eastern Europe and affects women, men and children from every walk of life. One in four deaths among people with HIV is linked to TB - that's about half a million people who die unnecessarily each year.

"Every three minutes a person living with HIV has his or her life cut off prematurely by TB. This is completely unacceptable, because TB is a preventable and curable disease," said Dr Jorge Sampaio, the United Nations Secretary-General's Special Envoy to Stop TB.

Global public health leaders gathered at this conference have committed to an ambitious new agenda to stop these preventable deaths. Dr Sampaio presided today over the signing of a landmark document: a memorandum of understanding between the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Stop TB Partnership. The agreement binds the two organizations together in a common goal: to strive towards halving the number of people living with HIV who die from TB by 2015, compared to 2004 levels. Provision of life-saving antiretroviral treatment for all TB patients living with HIV is another key objective.

“We already have the tools to keep people living with HIV from dying of TB ”, said Mr Michel Sidibé, Executive Director of UNAIDS, ”We must join our TB partners to promote an evidence and human rights based approach to tackling TB and HIV. Together we can virtually eliminate TB related AIDS deaths.”

Stop TB and UNAIDS will press government health programmes to reach all people in need of care for TB/HIV by integrating the services that provide diagnosis and treatment for both conditions; and also seek to increase the resources needed to accomplish this goal. Another overarching objective is to galvanize civil society organizations, communities affected by TB and HIV and the private sector to form strong partnerships aimed at jointly addressing TB/HIV.

In keeping with the focus of this year's AIDS conference, the signers stressed the needs of marginalized groups. "We call on the world's leaders to promote full access to HIV and TB services for women and girls, orphans, displaced persons, migrants, prisoners, men who have sex with men, people who use drugs other vulnerable groups," said Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership.

During 2010 and 2011 the leadership of Stop TB and UNAIDS will make at least two joint visits to countries heavily affected by TB/HIV per year and promote their new initiative at least one international event per year.