Colleen Daniels Stop TB Department

World Health Organisation

TB, HIV and Drug Use The overview

• TB is caused by infection with a bacteria

– Mycobacterium tuberculosis

• It is spread like the common cold

through respiratory droplets in the air – Coughing, sneezing, talking, singing…

• 1/3 of the world’s population are

infected with TB (not active disease)

• Bacteria lives dormant in the lung – latent TB infection

• Only 5-10% actually develop TB disease during their lifetime (if HIV negative)

• If HIV positive this increases to 10% every year

What is Tuberculosis (TB)?

What is HIV/TB?

• One third of the 33 million people living with HIV is co-infected with TB

• TB is a leading cause of death among people living with HIV

• The majority of cases of tuberculosis in people

living with HIV, occur in sub-Saharan Africa, where

up to 80% of TB patients may be co-infected with

HIV

• Also very high levels of co-infection in certain high

risk groups

Global Burden of HIV/TB/IDU 2008

HIV

• 33.2 million people living with HIV

• 2.5 million new infections

• 2.1 million people died of AIDS

(AIDS Epidemic Update 2009)

Tuberculosis

• 9.4 million new cases

• 1.3 million people died of TB

• An additional 0.5 million HIV deaths due to TB

(WHO- Update Global TB

Control 2009)

IDU

• 15.9 million people who inject drugs

• 3 million HIV positive

• Eastern Euro – 57% new HIV infections among IDUs

(AIDS Epidemic Update 2009)

TB, HIV and injecting drug use - Overlap

TB HIV

15.9 million

9.3 million

? million

?

Injecting Drug Use

3 million

1.4 million 33.3 million

People who use

drugs have 10-30%

increased risk of

getting TB

Vulnerable groups

• Substance users

– Injecting drug users

– Other drug users

– Alcohol excess

– Smoking

• Migrant populations

– Economic

– Social

• Refugees

• Children/young people

• Prisoners

• Indigenous populations

Global response in 2008

• 1.4 million HIV positive TB cases

– 500,000 people died of HIV associated TB

• Only 1.4 million TB patients (out of 9m) tested

for HIV

– Of those HIV positive; 200,000 given CPT and

100,000 ART

• Only 1.4 million PLHIV (out of 33.3m) screened

for TB

– Only 48,000 given IPT

• 8 out of every 100 IDUs received OST

Collaborative TB/HIV activities

A. Establish the mechanism for collaboration

• A.1. TB/HIV coordinating bodies • A.2. HIV surveillance among TB patient • A.3. TB/HIV planning • A.4. TB/HIV monitoring and evaluation B. To decrease the burden of TB in PLWHA

• B.1. Intensified TB case finding • B.2. Isoniazid preventive therapy • B.3. TB infection control C. To decrease the burden of HIV in TB patients

• C.1. HIV testing and counselling • C.2. HIV preventive methods • C.3. Cotrimoxazole preventive therapy • C.4. HIV/AIDS care and support • C.5. Antiretroviral therapy to TB patients.

HIV • HIV epidemic began 25 years

ago

• History of strong political

advocacy/activism

• Strong global awareness

• Rapid test on finger prick or

saliva in minutes, simple and

accurate

• Dozens of new drugs to treat HIV

TB • TB thousands of years old

• Recent adoption of

advocacy/activism

• TB a forgotten disease

• Diagnostic test more than 120

years old, tedious & inaccurate

• No new TB drugs for >40 years

Power of advocacy

No more people living with HIV, dying of TB!

Barriers • Advocacy/activism

• Inadequate tools/lack of research

• Weak health systems – human resources

• Lack of collaboration and poor integration at patient level

• No integration with harm reduction programs – No provision OST

• Poor implementation of the Three I’s

• Lack of social mobilization

• HIV continues to spread

Summary

• TB, HIV and drug use closely linked

• TB is preventable & curable in people living with HIV &

drug users

• Universal access means access to comprehensive TB

and HIV prevention, care and treatment linked to

services for people who use drugs

• All stakeholders in TB, HIV and drug use need to work

closely together to reduce the interrelated impact