World Health Organization issues new policy to step up TB/HIV efforts

Keith Alcorn
Published: 02 March 2012

Around 910,000 lives were saved between 2005 and 2010 as a result of closer working relationships between HIV and TB programmes, according to estimates released today by the World Health Organization. However, further progress is still needed: around 40% of TB patients in sub-Saharan Africa did not receive an HIV test in 2010, a basic indicator of how well TB and HIV services are working together.

The World Health Organization today released new guidance for policy makers and managers in TB and HIV programmes to encourage scale up of fully integrated programmes. The guidance updates a 2004 interim policy, based on experience of implementing joint HIV/TB activities.

TB is one of the leading causes of death in people living with HIV, and WHO estimates that around 350,000 people with HIV infection died of TB in 2010, while 1.1 million people living with HIV developed TB in the same year, predominantly in sub-Saharan Africa.

Since efforts to integrate TB and HIV services began to accelerate in 2005 over 100 countries have adopted WHO’s 2004 recommendations. In 2005 only 14% of TB patients estimated to have HIV infection were receiving HIV-related medical care, but by 2010 around 60% were registered with an HIV clinic. Similarly the proportion of HIV patients who received TB screening increased from 200,000 in 2005 to 2.3 million in 2010.

But in some countries and districts the links between HIV and TB programmes remain weak or underfunded. As a result people who develop symptoms of TB may go untested for HIV, while people living with HIV may not be screened regularly for TB, nor given medication which can prevent the development of active TB.

The new policy emphasises the need to maximise the delivery of a range of medical and preventive interventions:

  • Routine HIV testing for TB patients, people with symptoms of TB, and their partners or family members;

  • The use of a simple clinical algorithm for TB screening that relies on the absence or presence of 4 symptoms: current cough, weight loss, fever and night sweats, to identify people living with HIV eligible for at least 6 months of isoniazid preventive therapy (IPT) or for further diagnostic investigations for TB.

  • Provision of co-trimoxazole, a cost-effective medicine to prevent against lung or other infections for all TB patients who are infected with HIV;

  • Starting all TB patients with HIV on antiretroviral therapy (ART) as soon as possible (and within the first 2 weeks of starting anti-TB treatment) regardless of immune system measurements;
  • Evidence-based methods to prevent the acquisition of HIV for TB patients, their families and communities (infection control).

“We must address TB as we manage HIV,” said Dr Gottfried Hirnschall, Director of WHO's HIV/AIDS Department. “We have shown over the last five years what can be done. To continue the progress and save more lives, comprehensive HIV services must include the Three I’s for HIV/TB strategy: isoniazid preventive therapy, intensified screening and infection control for TB, and it should also include earlier treatment for HIV for those that are eligible.”

The new policy encourages national and local programmes to achieve greater integration and wider coverage of services by:

  • Establishing mechanisms for delivery of integrated TB and HIV services at the same place and time as much as possible;

  • Integrating TB and HIV services into other health programmes such as maternal and child health, harm reduction services and prisons health services;

  • Strengthening monitoring and evaluation in one national system using standardised and harmonised TB/HIV reporting and recording formats and indicators;

  • Incorporating TB screening as a routine practice into HIV surveillance systems;

“This framework is the international standard for the prevention, care and treatment of TB and HIV patients to reduce deaths; and we have strong evidence that it works,” said Dr Mario Raviglione, WHO Director of the Stop TB Department. “Now is the time to build on these actions and break the chain that links TB and HIV with death for so many people.”

Further information

Download the new policy here.