IAS 2019: Preventing TB — the leading killer of people with HIV — remains tangential to global HIV responses

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Science Speaks is in Mexico City covering IAS 2019 the 10th IAS Conference on HIV Science from July 21 – 24.

MEXICO CITY – In a day-long, pre-conference meeting devoted to addressing tuberculosis prevention among people living with HIV, which continues to account for one in three HIV-related deaths globally, experts discussed the urgent need to listen to communities about their TB prevention needs and offer people-centered interventions. This includes integrating TB prevention services at family planning clinics, maternal and child health centers and opioid medication treatment centers, along with the developing shorter treatment regimens.

Despite World Health Organization recommendations to provide TB preventative treatment to all people living with HIV and UNAIDS’ goal of reaching 90 percent of people living with HIV with TB prevention services by 2020, only one million people infected with HIV started preventive treatment for TB in 2017, Andrea Howard of ICAP said, leaving millions without the service they need to prevent TB illness.

Most countries have policies on providing TB prevention services, Suvanand Sahu of the Stop TB Partnership said, but only 67 out of 200 countries have reported on TB prevention uptake. “If you don’t measure something, it won’t get done,” he said. Only one country – South Africa – accounted for 39 percent of all global TB prevention coverage, he said.

To increase TB prevention coverage, responses must address structural barriers and community needs which are “things we’ve done for HIV but not for TB,” Meg Doherty of the World Health Organization said.

That includes going to where the people are and integrating prevention into delivery of services that include sexual, reproductive, prenatal and child health care. When ICAP provided technical assistance on scaling up TB prevention at four such facilities in eSwatini, TB prevention coverage increased by 60 percent among women living with HIV seeking family planning services, and 35 percent among women seeking antenatal services. Overall, TB prevention increased by 46 percent among all programs, Howard said.

When ICAP worked with the Ministry of Health in Sierra Leone to provide technical assistance at 14 facilities, coverage increased from a baseline 3 percent to 70 percent, Howard said. Uptake, however, dropped precipitously after a national stockout of isoniazid, the primary drug used in TB prevention.

“Ensuring an adequate supply of isoniazid to meet an increased demand is critical for success,” she said.

ICAP also saw successes in integrating TB prevention and HIV services at opioid medication treatment centers in Kazakhstan, Kyrgyzstan and Tajikistan, where 137 people received TB prevention services at 14 sites where they were already receiving HIV treatment and adherence support, Howard said.

Further integration of TB prevention treatment in maternal and child health programs is critical, Jyoti Mathad of Weill Cornell Medicine said. Studies show pregnancy doubles the risk of TB disease because of a weakened immune system, resulting in increased risk of pre-eclampsia, miscarriage, hospitalization and other adverse outcomes.

“When they get TB, bad things happen,” Mathad said. Pregnant women infected with TB but not HIV are at 25 times higher risk of dying, while women living with HIV are 37 times more likely to die from TB while pregnant. With weaker immune systems Infants have a 3.4 times higher chance of dying, she said.

“We have to have increased recognition that TB prevention has to be reoriented to place people at the center of responses,” Maureen Murenga, an activist from Kenya said.

“TB prevention services must respect users’ needs,” she said, “People know which prevention methods are right for them.”

2 thoughts on “IAS 2019: Preventing TB — the leading killer of people with HIV — remains tangential to global HIV responses

  1. Reuben Granich

    Nice article. Eerily familiar.

    Over the past 20 years we missed opportunities to provide earlier HIV treatment combined with treatment of latent TB infection. Test and treat of HIV to prevent TB was blocked by “experts” for years until 2015 (see Suthar et al PlosMed 2012 re ART and reduced risk of TB). Despite millions spent on building the evidence base, most people living with HIV have not been given access to treatment for latent TB infection.

    See our meeting from 10 years ago that built on the 1998 guidelines. I think coverage was less than 5% then as well. Basically no change for 20 years.
    https://www.who.int/hiv/pub/tb/3is_mreport/en/

    We tried to combine INH with cotrimoxazole in fixed dose combo pill as well (see WHO Essential Meds minutes and Harries et al)–good idea but apparently did not make a major difference in delivery.

    Meetings are helpful to raise awareness but need to do something different or will be in same place in 10 years!

    Reply
  2. Pingback: IAS 2019: While plans for HIV control innovations accelerate, community input remains an afterthought | Science Speaks: Global ID News

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