The 17th Core Group Meeting of the TB/HIV Working Group kicked off in Beijing China with opening remarks from Dr. Yu Jingin, director of the Disease Control Bureau of the China Ministry of Health, and Dr. Wang You, director of the China Centers for Disease Control (CDC).
Dr. Jingin informed the international audience that China has 14 percent of all the world’s TB cases and a low incidence, but growing numbers of HIV cases. The Chinese government has developed collaborative mechanisms between HIV and TB programs with detailed guidelines for the bi-directional screening of HIV and TB. So far, 300,000 TB patients have been screened for HIV and 120,000 HIV patients have been screened for TB. The government has provided free isoniazid preventive therapy (IPT) for 12,000 co-infected patients. He also pointed out that international support has been indispensable to their work.
He thanked the World Health Organization (WHO) for hosting the meeting in Beijing, giving the Chinese additional opportunities to learn from other international experiences.
Dr. Wang Yu noted that China has 1 million newly registered TB cases including 120,000 cases of multidrug-resistant (MDR) TB. By the end of last summer, China had 430,000 cumulative cases of HIV infection.
In China HIV prevalence varies greatly by region. Ten percent of the country is home to 70 percent of the HIV cases. While the initial drivers of HIV infection in China were blood transfusions and injection drug use, sexual transmission is the main mode of HIV transmission. TB is one of the most common opportunistic infections among persons living with HIV and a major public health challenge for China. According to Wu, “We are fighting on two fronts.”
In the ten years since 2001, China has dramatically stepped up its response to tuberculosis, has treated 8.8 million cases of pulmonary TB and reduced TB incidence by 50 percent. Smear positive pulmonary TB went down by 50 percent over that period. Through scale-up of antiretroviral therapy (ART), the longevity of persons living with HIV has also improved. China has done an analysis of HIV testing among TB cases especially in the regions with high HIV incidence and looked at the research studies about the benefits of IPT. They began TB/HIV collaborative activities in 2006, improved their surveillance, and established reporting for HIV and TB. TB symptom screening is now required in HIV treatment settings, but great challenges remain in diagnosing TB in HIV-infected patients and mortality in co-infected individuals is high.
Mark Sterling from UNAIDS closed the opening panel by noting that the clock is ticking on the WHO goal to cut in half the number of deaths from TB among people with HIV by 2015. One in five TB/HIV co-infections comes from the western Pacific region of the world and achieving this goal requires success in Asia and in China specifically. To date, Asia is not matching global progress elsewhere.
Sterling noted that China recently hosted a conference on HIV and reported that ART coverage has increased by 50 percent, prevention of mother-to-child transmission has more than doubled, and services to marginalized populations have increased by more than one-third—all over a two-year period. This progress reflects the doubling of resources from China to respond to HIV over the last two years. China has set ambitious targets for 2015 in many of these areas.
In regard to TB/HIV co-infection, he noted some key issues to consider:
- Is there a need for specific targets to reduce TB deaths among persons with HIV?
- Is China ready to scale up IPT nationally and to ensure adequate resources to do so?
- Is there a need to increase the focus on high-risk populations where the burden of disease is the greatest—people who use drugs and access to services in “enclosed settings?”
He also stressed the need to engage community-based organizations and the importance of coordinated action among the various service providers.