Tuberculosis: Time to Re-think

March 31, 2011

Posted by Gitau Mburu

Senior Advisor, Health Systems and Services, International HIV/AIDS Alliance

First published on the Global Health blog, 23 March 2011.

World TB Day is a reminder of the dangers of TB for those living with HIV.

Marking World TB day on the 24th March is a stark reminder that TB remains the single most important threat to the 33 million people living with HIV today.

Yet it is utter irony that tuberculosis continues to a formidable enemy, not only because it is fully preventable but also because it is an entirely curable disease. Tuberculosis is rapidly taking away the gains we have made from HIV treatment as it is the most frequent illness amongst people living with HIV, including those on antiretroviral therapy.

Of the people living with HIV who struggle to be alive today, at least 1.5 million are co-infected with TB and at least 350,000 of them will succumb to tuberculosis this year. In 2009, 380,000 people living with HIV died from AIDS-related tuberculosis. In addition, people living with HIV are also faced with the threat of multi-drug resistant tuberculosis.

But why does TB, a disease which was once thought to be conquered in developed countries continue to be a source of so many deaths?

Firstly, tuberculosis has been one of the most neglected diseases over several decades. Although treatment is cheap, little global investment has gone into funding to support TB service delivery, development of new TB diagnostics, or innovation of more effective and shorter treatment regimens.

In addition, TB and HIV/AIDS programs are still implementing treatment independently, with limited integration and collaboration, even in settings where these two epidemics overlap significantly. Lack of partnerships between TB and HIV organizations – including at the community level – further compounds this problem as it presents a significant barrier toward successful integration of TB into HIV programs (and vice versa); thereby limiting provision of comprehensive and holistic TB and HIV services to the very people who need them the most.

A lack of political commitment, limited funding for collaborative activities at the national and sub-national levels, and overstretched human and infrastructural resources continue to be major challenges in forming effective partnerships to tackle tuberculosis, especially in the context of HIV.

This year’s World TB day provides an opportunity for world leaders to reaffirm their commitment to fight tuberculosis. The burden of TB disease is much higher now than ever before and unless renewed global political and financial commitment to tackle TB disease is put in place, it will continue to claim million of lives, including lives of people living with HIV, on whom huge financial resources are spent to keep alive.

The newly launched World Health Organization Global Plan to Stop TB 2011-2015 identifies key strategies to fight tuberculosis but it requires action to realise its targets if we are to stop this unnecessary killer. There a critical need to empower affected individuals, families and communities to make a bigger contribution by involving them in planning and implementation of TB and HIV treatment and care services. The onus is on us all.

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