Info Service on Health Issues (March 09/06)
International Calls for New Strategy
WHO Report shows that the incidence of TB co-infection with HIV has
been grossly underestimated.
advocacy groups agree this problem was an international health priority
it has received little funding or attention.
following story is reproduced with permission from IPS and South-North
Development Monitor SUNS #6668, 26 March 2009
convergence sparks calls for new strategy
By Ben Case, IPS, New York, 24 March 2009
On World Tuberculosis Day Tuesday, the World Health Organisation (WHO)
released a report showing that new surveillance techniques and more
complete country reports reveal the incidence of tuberculosis (TB) co-infection
with HIV to be almost double what was previously thought.
Tuberculosis is the leading cause of death among people who are HIV-positive,
but only two percent of those diagnosed with HIV worldwide are also
tested for TB. The WHO report found that a quarter of TB deaths worldwide
are related to HIV, twice the number previously estimated.
According to Dr. Carol Hamilton, co-chair of the Infectious Diseases
Centre for Global Health Policy and Advocacy and a professor of medicine
at Duke University,
to a person who is HIV-positive, tuberculosis is a guaranteed death
sentence within six months, absent treatment.
The WHO reported that 1.77 million people died from TB in 2007, including
456,000 people with HIV, despite the fact that most forms of TB are
Coinciding with the WHO report was an analysis written by two advocacy
groups, Advocacy to Control Tuberculosis Internationally (ACTION) and
Infectious Disease Centre for Global Health Policy and Advocacy, that
details the severity of TB and HIV co-infections.
"The convergence of the co-epidemic is worse than we thought,"
said Joanne Carter, executive director at RESULTS Educational Fund,
which released the joint report. "The real point is that major
HIV/AIDS funding groups are not properly addressing the issue."
The RESULTS report focuses on several main HIV/AIDS prevention and treatment
groups, such as the President's Emergency Plan For AIDS Relief (PEPFAR),
the World Bank Multi-Country AIDS Programme (MAP) and the Global Fund.
According to the report, all of these groups published information stating
that TB and HIV co-infections was a priority, but there is little evidence
of the issue receiving any significant funding or attention.
Paul Jensen, global research coordinator for RESULTS, called the groups'
attention to co-infection "insufficient", saying, "There
is very modest resource allocation here. When HIV/TB focus does occur,
it is sporadic, meager and usually voluntary."
The MAP, which has committed $1.6 billion to the HIV/AIDS crisis since
its creation in 2000, does not disaggregate funding for tuberculosis
programmes, making it impossible to know exactly how much is committed
In addition, Jensen called the MAP budgets "incoherent", and
said "The funding for specific TB programmes is very poorly tracked."
Jensen added, "The World Bank says they have a commitment to integration
here but there is no strategy."
In another example, the Global Fund, which has contributed $15.2 billion
towards fighting HIV/AIDS, tuberculosis and malaria, includes the issue
of HIV and TB co-infection in its grant application forms only as a
footnote. Out of nine grant plans analysed in the report, only $6 million
was allocated to co-infection related issues.
The RESULTS report was adamant about the need for a sustained commitment
to tuberculosis prevention, treatment and especially education.
"TB is a contagious lung disease that has been recognised for over
a hundred years, and it has been curable for over 50 years, yet there
were still more cases worldwide in 2007 than in 2006," said Dr.
With proper diagnostics equipment, tuberculosis is easily detectable
through a sputum test and chest X-ray, but TB affects the poorest areas
and effected regions often have no access to this equipment.
These areas are also the most affected by HIV. According to the WHO,
in countries with high prevalence of HIV, 80% of people infected with
TB also have HIV.
"Medicine used to treat TB are getting weaker as TB figures out
how to evade the drugs," said Hamilton.
"We need US
leadership in funding for programmes and research."
But with the ongoing economic crisis, it seems more likely that funding
for these programmes will be cut. "We are all waiting to hear the
details but we're definitely worried," Carter said of future funding.
Funding for the Centres for Disease Control and Prevention (CDC), the
government agency responsible for tracking and eliminating TB in the
has been steadily decreasing over the past decade.
The US Congress recently passed legislation increasing funding to fight
TB, but whether that money will make it to its intended purpose after
the economic downturn remains to be seen.
President Obama's government stimulus package actually reduces funding
for the CDC and no money was specifically allocated to TB-related projects.
There are examples of countries with positive trends in treating the
HIV/TB co-infection. Since formally acknowledging a link between HIV
and TB-related deaths, Kenya
has managed to provide HIV testing for about 80% of patients with tuberculosis
and has taken measures to prevent the transmission of TB, which is airborne,
in HIV clinics.
The RESULTS report advocates for an increase in funding for programmes
targeting HIV/TB co-infection.
According to Dr. Richard Chaisson, director of the Johns Hopkins Centre
for Tuberculosis Research, the primary issue seems to be awareness of
the convergence of these two epidemics. "People need to understand
that HIV is the most important risk factor in TB patients, and visa
To Chaisson's view Carter added: "What we are trying to avoid are
the scenarios where people are being diagnosed with HIV and surviving
it but then dying of undiagnosed TB."
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