Tuberculosis (TB) is the leading cause of death among people living with HIV, accounting for around one third of AIDS-related deaths globally. Coordinated and scaled up efforts to prevent, diagnose and treat the two diseases had resulted in a 68% decline in TB deaths among people living with HIV between 2006 and 2019. However, in its 2021 Global Tuberculosis Report, the World Health Organization announced that TB deaths among people living with HIV increased for the first time in 13 years, from 209 000 in 2019 to 214 000 in 2020.
“The increase in TB deaths among people living with HIV is alarming and demonstrates the fragility of pandemic progress,” said Winnie Byanyima, Executive Director of UNAIDS. “When COVID-19 hit, global attention on HIV and TB shifted as the world focused on tackling the new pandemic. This has meant lives needlessly lost and important targets missed for HIV, TB and other diseases. Urgent action and increased investments are needed to get us back on track.”
People living with HIV are 18 times more likely to develop TB disease. Although around 85% of people who develop TB disease can be successfully treated, the treatment success rates for people living with HIV are much lower, at around 77%. This demonstrates the importance of scaling up prevention efforts as well as treatment for the two diseases.
Concerted and collective action in this area has saved lives in recent years. Between 2018 and 2020, some 7.5 million people living with HIV were given preventive TB treatment, surpassing the global target of 6 million. But much more needs to be done to address the underlying inequalities that continue to fuel the spread of HIV and TB.
Refugees and displaced people are at particularly high risk of developing TB. At the end of 2020, the Office of the United Nations High Commissioner for Refugees estimated that 82.4 million people around the world were displaced from their homes. The war in Ukraine has already forced 3.5 million people to flee the country and millions more are internally displaced. It is critical that Ukraine and its neighbouring countries receive urgent support to provide essential health services for people affected by the war, including services for TB and HIV.
“In this time of crisis, there is an opportunity to build a pandemic-resilient future if leaders work together to tackle the inequalities that endanger us all,” said Ms Byanyima. “While AIDS, TB and COVID-19 each spread in unique ways, we are watching as each is driven by social and economic inequality that leaves some communities more vulnerable and the whole world at risk. We can address those inequalities, or we can let these pandemics continue—the power is in our hands.”
The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the leading international funder of TB programmes; however, COVID-19 has had a devastating impact. Between 2019 and 2020, the number of people treated for TB in the countries where the Global Fund invests fell by around 1 million. This year, at its seventh replenishment, the Global Fund is calling for an additional US$ 18 billion to save 20 million lives and get the world back on track towards ending HIV, TB and malaria. To end the three diseases by 2030 and build strong national health systems to respond to emerging pandemics, it is essential that the Global Fund be fully funded.
UNAIDS is continuing to work with partners to reach the HIV/TB targets set for 2025, which include ensuring that 90% of people living with HIV receive preventive treatment for TB and reducing TB-related deaths among people living with HIV by 80% (from a 2010 baseline). To make this happen will require the Global Fund to be fully funded and that investments be made in research and development, in expanding services as well as in adopting new and innovative strategies to reach everyone in need.