1. Pre-conference Meeting Report
Sevim Ahmedov
Sr TB Technical Adviser, USAID

2. Main Topics and Messages
TB is the leading infectious disease killer of PLHIV
Proven interventions to reduce TB mortality among PLHIV exist but require urgent scaling-up of implementation
More resources are needed to address TB funding gaps
The UN High-Level Meeting (UN HLM) on TB (September 2018) provides a unique opportunity to propel the TB and TB/HIV response
Call to Action on TB/HIV!

3. Trends of Estimated TB and HIV deaths, 2000–2016
37% of the 1 million AIDS deaths in 2016 were due to TB
Source: Global TB Report, 2017

4. Impressive scale-up of ART in People living with HIV
21.7 million PLHIV receiving ART by Dec 2017
59% of 36.9M PLHIV
Source: UNAIDS/WHO estimate

5. ART is necessary, but not sufficient, to prevent TB
TB risk remains high among HIV+ people on long-term ART
Gupta PLoS ONE 2012;7:e34156

6. ART + TPT = better prevention
Rangaka Lancet 2014;384:682
TEMPRANO NEJM 2015;373:808

7. Only 12/30 high TBHIV burden countries reported on IPT in 2016
Initiation of TB preventive treatment to People living with HIV,
Yet despite this progress has been limited.
Graph shows countries reporting implementation of IPT in PLHIV up until 2016 worldwide.
Only 60 countries reported in 2017 –including 12 of the 30 high burden countries.
Source: Global Tuberculosis Report 2017
Only 12/30 high TBHIV burden countries reported on IPT in 2016

8. Gap in TB detection and TB preventive treatment for people who were newly enrolled in HIV care in high burden countries in 2016
71%
86%
83%
64%
83%
71%
64%
23%
48%
42%
21%
This bar chart shows gaps in green of people newly enrolled in HIV care that have either not been detected with TB or who have not been initiated on TB preventive treatment. So among countries reporting TB prevention, the gap ranges from as high as 86% to 21%.
Source: Global Tuberculosis Report 2017
Considerable gaps in coverage in reporting countries with high burden of TB and HIV-associated TB

9. Treatment options
3RH should be offered as an alternative to 6H for children and adolescents aged < 15 years. (New)
3HP treatment may be offered as an alternative to 6H for both adults and children in countries with a high TB incidence.(New)
Intervention
Comparator N
Active TB
Mortality
AEs
Hepato-toxicity
Completion rate
Adults with HIV
3HP
6H or 9H 2
0.73
( )
0.75
( )
0.63
( )
0.26
( )
1.25
( )
continuous INH 1
1.50
( )
1.06
( )
0.20
( )
0.05
( )
1.59
( )
Adults without HIV 9H
0.44
( )
( )
0.87
( )
0.16
( )
1.19
( )
Children and adolescents
0.13
( )
0.18
( )
0.88
( ) -
1.09
( )

10. Summary of Recent Advances
TB preventive therapy SAVES LIVES for people with HIV (TEMPRANO and REALITY)
6 months of IPT has durable benefit, even in African settings
ART is essential and has additional benefit
3HP is a promising option for HIV+ people
1HP could be transformational for global TB
We can probably do even better
Bedaquiline alone or in combination with rifapentine
Injectable bedaquiline?

11. Chaisson and Golub, Lancet Global Health, 2017

12. TB Resource needs updated up to 2022
For Implementation
During , 65 billion USD will be needed with an average annual need of 13 billion USD
Current funding needs to doubled
For Research and Development
Annual funding is about 0.7 billion USD with a gap of 1.3 billion USD per annum
Current funding needs to be tripled

13. How do we meet the resource needs for TB
Increase domestic funding
Increase external funding
Other sources of funding: Innovative funding mechanisms, loans, bonds, insurance, private sector resources, etc.
Smart investments and efficiency gains
HIV budgets should fund TB-related care for PLHIV
ART for co-infected
TB case finding among PLHIV
Preventive TB therapy for PLHIV

14. Concluding notes Dr. Pillay
Strategies are clear: WHO and Stop TB Partnership
We can get political commitment but we must use every opportunity to make the case for the end of TB as a public health threat
We need to mobilise all politicians to ensure that TB gets the budget it needs at local and global levels
Need to work closely with diplomats in NYC to get the best possible political declaration in September
Engagement with the community and civil society is crucial
Lets not ‘waste’ the opportunity presented by the HLM on TB!

15. Together we can prevent 2 million deaths by 2022
Key Asks from HIV/TB Stakeholders and Communities
Transform the TB/HIV response to be more equitable, rights based and people centred
Galvanize stakeholders at all levels, and ensure effective use of all available resources to address TB/HIV co-infection
Reach all people living with TB/HIV co-infection by eliminating gaps and barriers in access to prevention, diagnosis and treatment
Accelerate the development and implementation of new prevention, diagnostic and treatment tools and technologies to address TB/HIV co‑infection
Commit to rigorous monitoring and evaluation of programs that are in place, and ensure that TB/HIV targets are included in country-level accountability frameworks