Colleen Daniels

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TB, HIV and Drug Use The overview
Colleen Daniels Stop TB Department World Health
Organisation
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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 worlds 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

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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

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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
• (AIDS Epidemic Update 2009)

• Tuberculosis
• 9.4 million new cases
• 1.3 million people died of TB
• An additional 0.5 million HIV deaths due to TB
• (WHO- Update Global TB Control 2009)

• IDU
• 15.9 million people who inject drugs
• 3 million HIV positive
• Eastern Euro 57 new HIV infections among IDUs
• (AIDS Epidemic Update 2009)

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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
?
HIV
TB
9.3 million
1.4 million
33.3 million
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Vulnerable groups

• Substance users
• Injecting drug users
• Other drug users
• Alcohol excess
• Smoking
• Migrant populations
• Economic
• Social
• Refugees
• Children/young people
• Prisoners
• Indigenous populations

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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

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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.

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HIV
Power of advocacy
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
• Dozens of new drugs to treat HIV

• 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 gt40 years

No more people living with HIV, dying of TB!
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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 Is
• Lack of social mobilization
• HIV continues to spread

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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