Call for scale up of TB services for people living with HIV and people who use drugs

Urgent attention is needed to address critical funding gaps in tuberculosis (TB) care and control, as well as knowledge gaps in treatment for multi-drug and extensively drug resistance TB and diagnostics, say the Global Network of People living with HIV (GNP+) and the International Network of People who Use Drugs (INPUD).

Urgent attention is needed to address critical funding gaps in tuberculosis (TB) care and control, as well as knowledge gaps in treatment for multi-drug and extensively drug resistance TB and diagnostics, say the Global Network of People living with HIV (GNP+) and the International Network of People who Use Drugs (INPUD).

TB remains an unprecedented crisis. In 2011, there were an estimated 8.7 million new cases of TB and about one in six of these (13%) are among people living with HIV. HIV and TB co-infection makes up one-third of all TB-related deaths worldwide, TB is a growing threat to people who use drugs, particularly when set against the backdrop of high vulnerability to, and prevalence of HIV.

Prisons have been identified as perfect cauldrons for the transmission of both HIV and TB, including drug resistant strains of the latter. Given the almost universal criminalisation of people who use drugs and their high rates of imprisonment, the threat of HIV and TB infection amongst this population is especially high.

In 2011, still less than half of people living with HIV co-infected with TB were started on Anti-Retroviral Treatment (ART). This coverage must be doubled to meet WHO’s recommendation of offering ART to all people living with both HIV and TB irrespective of their CD4 counts.

“Scaling up combined voluntary HIV and TB testing and treatment will save millions of lives of people living with HIV,” says Kevin Moody, International Coordinator and CEO of GNP+. “TB is one of the biggest killers amongst people living with HIV, and we need to urgently close the funding and research gaps to ensure responsible coverage and quality treatment interventions for HIV and TB.”

“While the development of new drugs and new vaccines is progressing, more research is needed to understand how novel TB regimens to treat multi-drug resistant (MDR) or extensively-drug resistant (XDR) TB interact with ARVs or people living with HIV or those who inject drugs, it is crucial to understand how the new TB regimens interact with drug substitution therapies such as methadone and buprenorphine,” says Eliot Albers, Executive Director of INPUD.

GNP+ and INPUD call on the public and private sector to join forces to stimulate innovation and realize studies on interactions between ART and TB regimens, improved diagnostics of MDR and XDR-TB as well as the different TB vaccine candidates that are undergoing clinical trials worldwide. Accurate and rapid detection of TB and drug resistance is critical for improving care and decreasing the transmission of TB.

Point of care diagnostics, such as the WHO endorsed Gene Xpert test will ensure that people have quicker access to accurate health information and treatment, but costs remain a concern.

With global health financing reduced, and the replenishment of the Global Fund to Fight AIDS, TB and Malaria still hanging in the balance, the public health and humanitarian risks of letting the TB epidemic go unchecked, must be taken into account. We therefore call upon donor states to ensure that they meet their commitments in the next round of replenishment, and upon the Global Fund to ensure that where injecting drug use is present TB programs include a component addressing the needs of people who use drugs who are living with HIV and susceptible to TB infection.

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