Nov. 27, 2019

World AIDS Day Message by Dr Tereza Kasaeva.



Dr Tereza Kasaeva, Director, WHO Global TB Programme

  

30 November 2018 - This year marks a special milestone for the fight to end AIDS, as the world comes together to commemorate the 30th anniversary of the first World AIDS Day - that was initiated by WHO in 1988. 

The global theme this year is “Know your status”, I would like to add a simple mantra to this - “and be free from TB”. TB is the leading killer of people with HIV, and 920 000 people living with HIV fell ill with TB in 2017. Despite the progress in antiretroviral treatment coverage, nearly half of those who fall ill with HIV-associated TB and lose their lives from it, do not even reach the services they urgently need. TB is preventable and curable, including among people living with HIV. Being free from TB should not just be an aspiration for every person living with HIV but an ensured imperative, as we have the tools and resources available backed by high level commitments.

Two high level meetings in the past few years have put the spotlight on addressing the co-epidemics of TB and HIV. The United Nations High-Level Meeting on AIDS in 2016 led to commitments by Members States on reducing TB deaths among people living with HIV by 75% by 2020, compared with 2010. 

In September this year, Member States met once again in New York at the first-ever United Nations High-Level Meeting on TB and signed up to ambitious commitments in the Political Declaration on the fight against TB, that, if implemented will have considerable impact on HIV-associated TB. Two key commitments to be met by 2022, include diagnosing and successfully treating 40 million people with TB and providing preventive TB treatment to at least 30 million people, including at least 6 million people living with HIV. These commitments now need to become reality. 

It is now time for concerted action to accelerate the responses to both epidemics. I would like to highlight 4 priorities for action that can lead to quick gains: 

1. Integrated person-centered care at all levels: The frequent mismatch in distribution between TB and HIV services offers opportunities for TB and HIV programmes to come together, expand and decentralize integrated delivery to primary healthcare level as well as to community level, for reaching key affected populations, and households. TB and HIV are both considered household diseases as well as those that affect the most vulnerable. Activities relating to TB and HIV contact tracing and prevention in the home, or among vulnerable populations, could be combined and carried out by the same community healthcare worker.

2. Expanding access to preventive treatment: Whilst the evidence that TB preventive treatment reduces mortality by close to 40%, coverage still remains low. WHO’s updated and consolidated guidelines for programmatic management of latent TB infection, released in 2018, offer more options including fixed dose combinations, and shorter and more patient-friendly rifamycin-based regimens for people in high TB and HIV burden countries. Uptake of these recommendations, catalysed by renewed emphasis from partners and governments on TB preventive treatment will help accelerate scale-up towards meeting the target on TB prevention.

3. Maximizing use of limited resources: Global initiatives to find missing people with TB, to scale up TB treatment and prevention, and to ensure people living with HIV know their status and are on ART, could be aligned at country level to maximize use of available resources. Facility based TB screening for instance, in high burden countries could be leveraged to expand HIV testing among people with presumptive TB. Similarly, scale-up of HIV testing services should be used for expansion of TB screening and onward referral for diagnosis or prevention as appropriate.

4. Roll out and uptake of innovations: Roll-out of digital X-ray, strategic placement of multi-platforms e.g. Xpert MTB/RIF, and scale-up of other WHO-recommended diagnostics such as Lateral flow urine lipoarabinomannan assay within HIV services will help address the gaps in detecting HIV-associated TB. 

While there has been progress in addressing the co-epidemics of TB and HIV with 6.6 million lives saved since WHO first released guidelines on addressing HIV-associated TB in 2004, much more remains to be done. The good news is that we have strong political commitment with ambitious targets as well as renewed momentum and focus - it is now time to join forces to capitalize on this and break the trajectory of both epidemics. This will translate to saving millions from needless suffering and death.

Dr Tereza Kasaeva
 Director
 Global TB Programme
 World Health Organization



Dr Tereza Kasaeva, Director, WHO Global TB Programme



30 November 2018 - This year marks a special milestone for the fight to end AIDS, as the world comes together to commemorate the 30th anniversary of the first World AIDS Day - that was initiated by WHO in 1988.

The global theme this year is “Know your status”, I would like to add a simple mantra to this - “and be free from TB”. TB is the leading killer of people with HIV, and 920 000 people living with HIV fell ill with TB in 2017. Despite the progress in antiretroviral treatment coverage, nearly half of those who fall ill with HIV-associated TB and lose their lives from it, do not even reach the services they urgently need. TB is preventable and curable, including among people living with HIV. Being free from TB should not just be an aspiration for every person living with HIV but an ensured imperative, as we have the tools and resources available backed by high level commitments.

Two high level meetings in the past few years have put the spotlight on addressing the co-epidemics of TB and HIV. The United Nations High-Level Meeting on AIDS in 2016 led to commitments by Members States on reducing TB deaths among people living with HIV by 75% by 2020, compared with 2010.

In September this year, Member States met once again in New York at the first-ever United Nations High-Level Meeting on TB and signed up to ambitious commitments in the Political Declaration on the fight against TB, that, if implemented will have considerable impact on HIV-associated TB. Two key commitments to be met by 2022, include diagnosing and successfully treating 40 million people with TB and providing preventive TB treatment to at least 30 million people, including at least 6 million people living with HIV. These commitments now need to become reality.

It is now time for concerted action to accelerate the responses to both epidemics. I would like to highlight 4 priorities for action that can lead to quick gains:

1. Integrated person-centered care at all levels: The frequent mismatch in distribution between TB and HIV services offers opportunities for TB and HIV programmes to come together, expand and decentralize integrated delivery to primary healthcare level as well as to community level, for reaching key affected populations, and households. TB and HIV are both considered household diseases as well as those that affect the most vulnerable. Activities relating to TB and HIV contact tracing and prevention in the home, or among vulnerable populations, could be combined and carried out by the same community healthcare worker.

2. Expanding access to preventive treatment: Whilst the evidence that TB preventive treatment reduces mortality by close to 40%, coverage still remains low. WHO’s updated and consolidated guidelines for programmatic management of latent TB infection, released in 2018, offer more options including fixed dose combinations, and shorter and more patient-friendly rifamycin-based regimens for people in high TB and HIV burden countries. Uptake of these recommendations, catalysed by renewed emphasis from partners and governments on TB preventive treatment will help accelerate scale-up towards meeting the target on TB prevention.

3. Maximizing use of limited resources: Global initiatives to find missing people with TB, to scale up TB treatment and prevention, and to ensure people living with HIV know their status and are on ART, could be aligned at country level to maximize use of available resources. Facility based TB screening for instance, in high burden countries could be leveraged to expand HIV testing among people with presumptive TB. Similarly, scale-up of HIV testing services should be used for expansion of TB screening and onward referral for diagnosis or prevention as appropriate.

4. Roll out and uptake of innovations: Roll-out of digital X-ray, strategic placement of multi-platforms e.g. Xpert MTB/RIF, and scale-up of other WHO-recommended diagnostics such as Lateral flow urine lipoarabinomannan assay within HIV services will help address the gaps in detecting HIV-associated TB.

While there has been progress in addressing the co-epidemics of TB and HIV with 6.6 million lives saved since WHO first released guidelines on addressing HIV-associated TB in 2004, much more remains to be done. The good news is that we have strong political commitment with ambitious targets as well as renewed momentum and focus - it is now time to join forces to capitalize on this and break the trajectory of both epidemics. This will translate to saving millions from needless suffering and death.

Dr Tereza Kasaeva
Director
Global TB Programme
World Health Organization

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