The theme of this year’s World AIDS Day is “Global solidarity, resilient services”. At the 2016 UN High-level Meeting on ending AIDS, member states committed to a 75% reduction of TB deaths among people living with HIV by 2020, compared with 2010. Estimates for 2019 suggest that there has been some notable progress with a 63% reduction; however, the target for 2020 is unlikely to be reached, particularly in the context of the current COVID-19 pandemic.

A primary factor behind TB mortality among people with HIV is late diagnosis. This year’s WHO Global Tuberculosis Report highlighted that globally 44% of people with HIV-associated TB were not diagnosed in 2019. Autopsy studies among individuals who had died from AIDS report that almost half (46%) of them had TB that had not been detected prior to death. Enhancing the detection of TB among people living with HIV is therefore critical. TB preventive treatment (TPT) among people living with HIV has been shown to significantly reduce the risk of developing TB and dying from it. There has been impressive scale-up of TPT recently but only 50% of people starting ART initiated TPT in 2019, with a vast majority of those already on ART yet to receive it.   

The impact of COVID on the TB and TB/HIV response is palpable. Ongoing TB data collation and analysis from 200 countries has shown reduced access to care in both outpatient and inpatient facilities, impacting on the entire care cascade including prevention. COVID is also impacting on the HIV response and is driving poverty and malnutrition, putting people at increased risk of TB, and strengthening the argument for robust prevention measures. Strengthening systems for the maintenance and strengthening of HIV, TB/HIV and TB services is therefore even more crucial now given this potential negative impact of COVID-19.

Enhanced laboratory capacity, particularly with the increased availability of platforms such as chest X-ray and certain WHO-recommended rapid molecular diagnostic platforms that can be used for diagnosis of both COVID-19 and TB, should be leveraged to expand access to TB diagnosis, including for PLHIV. Similarly, the expanded institutional capacity for airborne infection control and contact tracing provides an opportunity to strengthen TB infection control and contact tracing. Likewise, digital innovations and experience with multi-month dispensing necessitated by the COVID-19 pandemic should be harnessed to catalyse the scale-up of TB preventive treatment needed to accelerate progress towards ending TB.

Now, more than ever, we need to expand and strengthen integration of services within the primary healthcare platform, optimizing differentiated service delivery, community engagement and the use of digital technologies to reach those most at risk of TB and HIV with screening, prevention, diagnosis and treatment.

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