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TB, HIV and Drug Use
The overview
Colleen Daniels
Stop TB Department
World Health Organisation
What is Tuberculosis (TB)?
•
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 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
Tuberculosis
• 9.4 million new
cases
• 1.3 million
people died of
TB
• An additional
0.5 million HIV
deaths due to
TB
IDU
• 15.9 million
people who
inject drugs
• 3 million HIV
positive
• Eastern Euro –
57% new HIV
infections
among IDUs
(AIDS Epidemic Update 2009)
(WHO- Update Global TB
Control 2009)
(AIDS Epidemic Update 2009)
TB, HIV and injecting drug use - Overlap
Injecting
Drug Use
People who use
drugs have 10-30%
increased risk of
getting TB
15.9 million
? million
3 million
?
TB
9.3 million
1.4 million
HIV
33.3 million
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.
Power of advocacy
HIV
TB
• 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
• 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
• Dozens of new drugs to treat HIV
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