Progress in Implementing collaborative TB/HIV activities Jintana Ngamvithayapong-Yanai and Haileyesus Getahun On behalf of the Global TB/HIV Working Group Meeting of 22 High Burden Countries and Core Groups of the StopTB Partnership. 30 October 2006. Paris, France.

WHO Interim policy on collaborative TB/HIV Activities, 2004

Global Plan to Stop TB (2006-2015) (Numbers in millions) 2010 2015 2006-15 PLHIV screened for TB 11 (61%) 22 (98%) 26 (100%) 206 PLHIV on IPT 1.2 (4%) 2.6 (8%) 3.1 (40%) 24 PLHIV on TB treatment 3.4 3.8 36 TB patients HIV tested 1.6 (47%) (81%) 2.9 (85%) 29 TB patients on ART 0.2 (44%) 0.3 (57%) 0.4 3.2 By 2006, 11 million or 61% of PLHIV attending HIV services will be screened for TB. By 2010 this number increases to 98% and by 2015 all PLHIV attending HIV services will be screened for TB. By 2006 4% of all PLHIV will be offered IPT. This increase into 8% in 2010 and 40% by 2015 By 2006 47% of TB patients treated in DOTS programmes will be HIV counselled and tested. This number will increase into 81 and 85% by 2010 and 2015 respectively. By 2006 44% of HIV positive and eligible TB patients in DOTS areas will be enrolled on ART. This number will be increase into 57% by 2010. Over the period of the plan over 200 million PLHIV will be screened for TB and 24 will get IPT. 36 million PLHIV will get TB treatment under DOTS programmes …..

C: Reducing the Burden of HIV in TB Patients Data (of 41 High Burden countries) Global Plan by 2006: 1.6 million Tested for HIV 200,000 Enrolled on ART

Progress in 2005 by region Region AFRO 494142 6% 28175 57105 5% 49% Estimated HIV+ TB cases (no) HIV+ TB cases detected (%) HIV+ TB cases detected (no) TB patients tested for HIV (no) TB patients tested for HIV (%) TB patients that test HIV+ (%) AFRO 494142 6% 28175 57105 5% 49% AMRO 17563 60% 10478 59668 27% 18% EMRO 7482 2% 175 2627 1% 7% WPRO 12213 4% 443 7039 EURO 2687 38% 1024 52817 26% SEARO 77919 9% 7027 31976 22% GLOBAL 612005 8% 47322 211232 Based on the countries reporting so far 8% of TB HIV co-infections are detected globally. At 60% the region with the highest percentage of estimated co-infected patients being detected is AMRO, followed by EURO 38% and then by SEARO with 9% detected. Provisional 2005 data from 163 countries reporting to the Global TB Control Report to be published in March 2007, suggest that 4% of tuberculosis patients were tested for HIV, that 22% of those tested test positive for HIV and that of the estimated TB HIV co-infected patients around 8% have been detected in the countries reporting so far. Although overall testing for HIV is 4% of TB patients. AMRO tests 27% and EURO tests 26% of TB patients for HIV Together these have 4.1% of the global TB/HIV co morbidity in the 163 countries tested to date. AFRO which has four fifth of the global TB HIV burden, lags behind with 5% of TB patients tested. However additional data from some African countries suggest that there has been a very rapid expansion of testing among TB patients in Rwanda, and Kenya where, in the first quarter of 2006, 64% and 49% of TB patients were tested. In Malawi in 2005 around 48% of TB patients were tested 69% of which were HIV positive.

Achievements: policy and tools Policy for accelerated diagnosis of TB in HIV prevalent settings TB/HIV Training material prepared and courses held Monitoring and evaluation systems developed and generating trend data

Achievements: advocacy African Heads of State, Abuja 2006, set TB/HIV targets UNGASS support for collaborative activities in TB and HIV, 2006 UNAIDS addressing TB (HIV /TB advisor posted) High visibility during Toronto AIDS Conference (included in rapporteur session)

Constraints and challenges Countries moving slowly Weak health systems Limited financial and human resources Coordination or integration of services is difficult Cultural differences and territorial concerns between TB and HIV programmes Lack of new and rapid tools to diagnose TB in PLHIV Ensuring that TB prevention, diagnosis and treatment become essential parts of HIV care

By 2015, to reduce half of TB mortality and to reverse the incidence Goal 6 target 8 of the MDGs: By 2015, to reduce half of TB mortality and to reverse the incidence