TB HIV Co-infection poses a critical challenge for the health-sector and for people living with HIV and TB. People living with HIV are 29 times more likely to develop TB disease than those who are HIV-negative. Starting in the 1980s, the HIV epidemic led to a major upsurge in TB cases and TB mortality in many countries.
In 2014, an estimated 1.2 million (12%) of the 9.6 million people who developed TB worldwide were HIV-positive. The number of people dying from HIV-associated TB peaked at 570 000 in 2004 and has since fallen to 390 000 in 2014 (a reduction of 32%). HIV-associated TB deaths accounted for 25% of all TB deaths (among HIV-negative and HIV-positive people) and one third of the estimated 1.2 million deaths from HIV/AIDS.
Globally, 51% of notified TB patients had a documented HIV test result in 2014, a small increase from 49% in 2013. WHO recommended the implementation of 12 collaborative TB/HIV activities. Between 2005 and 2014, an estimated 5.8 million lives were saved by TB/HIV interventions.
In 2014, coverage of antiretroviral therapy (ART) for notified TB patients who were known to be coinfected with HIV reached 77% globally. Further efforts are needed to reach the target of 100%. This is especially the case given that the number of HIV positive TB patients on ART in 2014 represented only 33% of the estimated number of people living with HIV who developed TB in 2014.
WHO recommends that routine HIV testing should be offered to all TB patients, to all those with TB signs and symptoms, and to partners of known HIV-positive TB patients. In 2014, 3.2 million notified TB patients had a documented HIV test result, equivalent to 51% of notified TB cases. This represented an increase from 3 million and 49% respectively in 2013, and more than 17 times the coverage reported in 2004.
ART is an intervention that can have an important impact on TB morbidity and mortality among HIV positive
TB patients. The number of notified HIV-positive TB patients on ART has grown from a very low level in 2004 to reach 392 000 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 41 high TB/HIV burden countries.
Preventing TB deaths among HIV-positive people requires intensified scale-up of TB prevention, diagnosis and treatment interventions, including earlier initiation of ART among people living with HIV and those with HIV-associated TB. Increased efforts in joint TB and HIV programming could facilitate further scale-up and consolidation of collaborative TB/HIV activities.
Joint activities between national TB and HIV/AIDS programmes are crucial to prevent, diagnose and treat TB among people living with HIV and HIV among people with TB. These include establishing mechanisms for collaboration, such as coordinating bodies, joint planning, surveillance and monitoring and evaluation; decreasing the burden of HIV among people with TB (with HIV testing and counseling for individuals and couples, co-trimoxazole preventive therapy, antiretroviral therapy and HIV prevention, care and support); and decreasing the burden of TB among people living with HIV (with the three I’s for HIV and TB: intensified case-finding; TB prevention with isoniazid preventive therapy and early access to antiretroviral therapy; and infection control for TB). Integrating HIV and TB services, when feasible, may be an important approach to improve access to services for people living with HIV, their families and the community.
Table: HIV testing for TB patients, provision of CPT and ART to HIV-positive TB patients, and initiation of IPT for people newly enrolled in HIV care, 2014
In 2014, a total 1068485 TB patients with known HIV status has tested in which 44,707 (4%) tested TB patients are HIV-positive among them 92% and 90 % are started CPT and ART in the SAARC region, which is slightly increased in ART from 2013.
In the SAARC region, India accounts for highest TB patients with known HIV status followed by Pakistan and Afghanistan in number. Around 93% of HIV-positive TB patients started CPT and 90% started ART in India at the end of 2014. However Bangladesh, Bhutan and Pakistan has 100 % HIV positive TB patients started ART. In 2014, Afghanistan, Nepal and Sri-Lanka has initiated HIV-positive people provided with IPT.