In 2004, the World Health Organization (WHO) published an interim policy on collaborative
TB/HIV activities in response to demand from countries for immediate guidance on actions
to decrease the dual burden of TB and HIV. As the evidence base for all the
recommendations was not complete at the time the policy was developed, the term interim
was applied.
The policy, which provided guidance for Member States and other partners on how to
address the HIV-related TB burden, has been implemented in many countries. The rapid
implementation of the interim policy with financial support from national governments, the
US Presidents Emergency Programme for AIDS Relief, the Global Fund for AIDS, Tuberculosis
and Malaria and other donor has catalysed important gains in the fight again TB and HIV.
The Policy led to the WHO Three Is for HIV/TB and earlier ART when eligible initiative which
has focused on preventing TB and HIV in people living with HIV.
Key achievements since the launch of the policy in 2004
o More than 100 countries are now testing more than half of their TB patients for HIV.
Progress was especially noteworthy in Africa, the number of countries testing more
than half their TB patients for HIV rose from five in 2005 to 31 in 2010.
o The number of people living with HIV screened for TB increased 12-fold, from nearly
200,000 in 2005 to over 2.3 million people in 2010.
o More than 60% of the estimated people living with HIV who developed active TB
were identified and treated for TB in 2010
o Thanks to increased implementation and scale-up of the above activities, it is
estimated that nearly a million lives were saved between 2005-2010.
Since the launch of the interim policy, additional evidence in the field of TB and HIV has been
generated through research and implementation experience from countries and used to
update the policy. The updated policy will help scale up and accelerate coordinated public
health interventions to further reduce deaths from this lethal combination of TB and HIV.
Q&A
What are the links between HIV and TB?
HIV and TB are so closely connected that the term co-epidemic or dual epidemic is often used to
describe their relationship. The intersecting epidemic is often denoted as TB/HIV or HIV/TB. HIV
affects the immune system and increases the likelihood of people acquiring new TB infection. People
living with HIV have an estimated 21 to 34 times greater risk of developing active TB than people
without HIV infection and in some settings people living with HIV have a 10% per year chance of
developing the disease. It also promotes both the progression of latent TB infection to active disease
and relapse of the disease in previously treated patients. TB is one of the leading causes of death in
HIV-infected people, 350 000 people died of HIV-related TB in 2010, which makes TB responsible for
one in four AIDS deaths.
maximizing the prevention impact of the Three Is for HIV/TB (Isoniazid preventive treatment,
Infection control for TB, and Intensified case finding) and earlier ART
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;
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 IPT or for further diagnostic investigations for TB.
As part of the Three Is for HIV/TB, ensuring the early initiation of ART in line with WHO
guidelines to prevent TB among people living with HIV.
Countries that included highest rates of enrolment of Co-trimoxazole Preventive Therapy (CPT) in
2010 included Burkina Faso, Burundi, India, Kenya, Lesotho, Mozambique, Malawi, Mali Myanmar,
Namibia, Rwanda, Swaziland, the United Republic of Tanzania and Uganda. The African and South
East Asia regions achieved particularly high levels of enrolment of CPT, with 76% and 87% of TB
patients known to be living with HIV provided with CPT respectively
The highest rates of enrolment of ART for TB patients were reported in countries in the Region of the
Americas, notably Brazil at 93%. Other examples include: Kenya that has increased the percentage
of TB patients receiving ART from 17% in 2005 to 48% in 2010; South Africa providing ART for 54% of
TB patients living with HIV in 2010; In India 57% of TB patients with HIV received ART in 2010.