Interim policy on collaborative TB/HIV activities

The HIV pandemic presents a massive challenge to the control of tuberculosis (TB) at all levels. Tuberculosis is one of the most common causes of morbidity and one of the leading causes of mortality in people living with HIV/AIDS. This document, produced by the World Health Organization, gives guidance to countries on which collaborative TB/HIV activities to implement and under what circumstances.

This policy does not call for the institution of a new specialist or independent disease control programme. It is complementary to and in synergy with the established core activities of tuberculosis and HIV/AIDS prevention and control programmes. The document describes the recommended collaborative TB/HIV activities grouped under the policy objectives which are to: (1) establish the mechanisms for collaboration; (2) decrease the burden of tuberculosis in people living with HIV/AIDS; and (3) decrease the burden of HIV in tuberculosis patients.

Key findings with respect to collaborative activities are as follows:

• HIV surveillance among TB patients is a critical activity for understanding the trends of the epidemic and for the development of sound strategies to address the dual epidemic.
• Joint strategic planning is essential and needs to cover collaborative activities as well as resource mobilisation, capacity-building and training, TB/HIV communication, enhanced community involvement, and operational research.
• Intensified case finding and treatment of TB among HIV infected persons prevents mortality and can be done at little additional cost.
• Evidence has shown that HIV voluntary counselling and testing (VCT) offers a direct entry point for care and support of TB patients with HIV. HIV testing should therefore be offered to all tuberculosis patients in settings with a high HIV prevalence.
• There is evidence that potent antiretroviral therapy can reduce the incidence of tuberculosis in HIV-positive persons by more than eight per cent.

The evidence for collaborative TB/HIV activities is limited and is still being generated in different settings. Therefore, this is a rolling policy, which will be continuously updated to reflect new evidence and best practices. Key recommendations include the following:

• Countries in which the national adult HIV prevalence rate is greater than one per cent should implement all recommended collaborative activities.
• Countries in which the national adult HIV prevalence rate is below one per cent but where there are administrative areas with an adult prevalence rate of greater than one per cent should implement all recommended collaborative activities for those administrative areas.
• Other areas should focus as a priority on groups at high risk from HIV and tuberculosis such as sex workers and those living in institutional settings such as prisons and military barracks.
• In countries where the national adult HIV prevalence rate is below one per cent throughout the country, the focus should be on the high risk groups.
• There is little evidence to show the exact magnitude and the mechanism by which collaborative TB/HIV activities contribute to attaining established HIV/AIDS and TB targets. Therefore, caution should be exercised in setting quantified targets for collaborative TB/HIV activities.