Memorandum submitted by Results UK
TB/HIV CO -EPIDEMIC
TB is the leading killer of people with AIDS,
responsible for up to one-third of AIDS deaths globally according
to the World Health Organization (WHO). It is estimated that up
to half of people living with HIV/AIDS will develop active TB
in their lifetimes. Once a person with HIV is diagnosed with TB
disease, he or she typically dies within weeks in the absence
of TB treatment. And unlike HIV, TB is curable in the vast majority
of cases—even in people with AIDS. Yet only slightly more
than half of those co-infected have access to effective TB treatment.
In sub-Saharan Africa in particular, the TB
epidemic is worsening primarily as a result of HIV/AIDS—and
is the only region in the world where TB rates are rising (by
some 5% annually). The situation is so severe that last August,
African Health Ministers and WHO declared TB a continent-wide
emergency. Despite the obvious, demonstrated links between TB
and HIV and the rising co-epidemic in sub-Saharan Africa this
is not adequately reflected in policy or practice, for example,
no reference to TB/HIV co-infection was made in DFID's publication,
Taking Action.
In countries such as India, which now carries
the highest burden of HIV/AIDS and TB it is critical that
significant investment in fighting the co-epidemic is made now.
This is even more necessary if the potential co-epidemic of HIV
and Multi-Drug Resistant (MDR-TB) is to be stymied.
Major gains can be made in reducing mortality
due to HIV/AIDS by investing in expanded TB control. Curing a
person of TB who is co-infected with HIV has been shown to typically
extend life by several years. This is particularly critical in
the "window" of the next several years as we are a long
way from universal access to ARVs. To provide universal TB treatment
would be cost-effective, as a full course of TB drugs to cure
one patient can be purchased through the Global TB Drug Facility
(GDF) for under £9.00.
In addition, existing TB services are probably
the single most important entry point for HIV testing, counselling
and treatment. [For example, in Kenya some 60% of TB patients
are HIV-positive; in Western Kenya, it is close to 90%.] The US
President's Emergency Plan for AIDS Relief (PEPFAR) estimates
that an additional 100,000 HIV patients could be placed on antiretroviral
therapy in Kenya alone, by offering HIV counselling and testing
to patients diagnosed with TB.
Given the challenges and delays in rolling out
ARVs—such as those demonstrated by WHO's 3x5 initiative—universal
access to TB treatment would save lives and buy precious time
in which to access ARVs. This time is needed: sub-Saharan Africa
has 81% of the world's estimated 741,000 cases of TB among HIV-positive
people—only 4% have access to ARVs. [58]
RECOMMENDATIONS
In line with commitments to integrate HIV and
TB services made in the Commission for Africa report and the TB
emergency declared in Africa, DFID could do far more to respond
to the HIV epidemic by mainstreaming the co-epidemic in its HIV/AIDS
portfolio and supporting countries to address TB/HIV co-epidemics.
DFID could achieve this by allocating country budget support resources
specifically for expanding TB services and tackling the TB/HIV
co-epidemic, particularly for sub-Saharan African countries, and
through investing in advocacy and communication initiatives to
encourage HIV patients to seek testing, counselling and treatment
services for TB and vice-versa. [59]
DFID should strategically increase and monitor
specific TB and TB/HIV bilateral expenditures. In conjunction
with this, DFID can play a key role by encouraging multilateral
funding sources such as the World Bank and the Global Fund to
recognise the challenge of the co-epidemic and proactively encourage
increased investments accordingly.
By providing significant long-term predictable
funding to mechanisms such as the Global Fund to Fight AIDS, TB
and Malaria and promoting the scaling-up of the WHO "two
diseases, one patient" strategy real progress can be made
in the fight against HIV/AIDS.
EVIDENCE SUBMITTED
BY RESULTS UK
RESULTS is an international citizens advocacy
organisation working to end hunger and the worst aspects of poverty.
Founded in 1980, RESULTS supports volunteer advocates across the
UK and six other countries worldwide (USA, Canada, Japan, Australia,
Germany and Mexico). As part of a nationwide network citizens
are supported in engaging with the democratic process and raising
awareness of development issues with community leaders, elected
representatives and the media.
RESULTS UK is currently working on a tuberculosis
(TB) advocacy project. "ACTION"—Advocacy to Control
TB Internationally—brings together RESULTS partners in the
UK, USA, Canada and Japan alongside national governments and civil
society in three high TB burden countries: India, Indonesia and
Kenya. The project aims to address and reverse the global TB epidemic
through policy analysis, education and high-level advocacy. With
a particular focus on Africa, Asia and Eastern Europe, the ACTION
project also educates policy makers on the growing TB/HIV epidemic
and the effectiveness of collaborative TB and HIV services in
high burden countries.
October 2006
58 WHO Report 2006, Global Tuberculosis Control:
Surveillance, Planning, Financing, Geneva, Switzerland (WHO/HTM/TB/2006.232). Back
59
Our Common Interest: Report of the Commission for Africa
(March 2005), p 197. Back
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