The World Health Organization (WHO) has released the consolidated guidelines on HIV-associated TB (TB/HIV) that provides a single comprehensive source for the latest evidence-informed TB/HIV recommendations. These guidelines are part of WHO's Consolidated guidelines on TB and comorbidities. To facilitate implementation of these guidelines, WHO has also published operational guidance on TB/HIV as part of the Operational handbook on TB and comorbidities, that also includes costed TB screening and diagnostic algorithms, models of integrated care and enablers for scaling up people-centred TB/HIV services. Adoption of the full package of WHO TB/HIV recommendations is expected to save more lives and further reduce the burden of HIV-associated TB.
"Collaborative TB/HIV activities are central to efforts to ending TB. To this end, at the UN High-Level Meeting on the Fight against TB last year, Member States committed to integrating systematic screening, prevention, treatment and care for TB and for HIV and other conditions within primary health care," said Dr Tereza Kasaeva, Director of WHO's Global Tuberculosis Programme. "The guidelines and operational handbook will equip countries with the tools to implement and scale-up interventions that help identify and ensure that people with HIV-associated TB are reached with life-saving interventions."
People with HIV are about 14 times more likely to develop TB disease, have poorer TB treatment outcomes and have three-fold higher mortality during TB treatment compared to people without HIV. Despite advances in the screening, diagnosis, treatment and prevention of TB disease, TB remains the leading cause of death among people with HIV worldwide. The guidelines and operational handbook aim to assist countries in scaling up and sustaining the TB/HIV response as part of people-centred care.
WHO recommended interventions, including the combination of TB treatment and antiretroviral treatment are estimated to have averted 9.2 million TB deaths among people living with HIV between 2005 and 2022. This progress follows the roll out of WHO's Interim policy on collaborative TB/HIV activities over a decade ago in response to demand from countries for immediate guidance on actions to decrease the dual burden of TB and HIV. In 2022, WHO also published the Framework for collaborative action on TB and comorbidities, to support countries establish and strengthen collaboration across health programmes and across sectors for the introduction and scale-up of collaborative action on TB and comorbidities.
"We possess the tools and technologies, and considerable progress has been achieved in reducing TB deaths among people living with HIV; nevertheless, TB still contributes to nearly a third of HIV-related deaths. Greater efforts are required to meet the 80% mortality reduction target for 2025 as agreed upon in the Member States' Political Declaration on HIV and AIDS. The new, shorter regimens of TB preventive therapy (TPT) must be made accessible to all people living with HIV to prevent TB and decrease mortality. Scaling this innovation will assist us in achieving the goal of providing TPT to at least 90% of people living with HIV by 2027 and to 95% by 2030, thereby saving lives," noted Dr Meg Doherty, Director of WHO's Global HIV, Hepatitis and STIs Programmes.
In recent years there have been remarkable developments in screening, diagnosis, treatment and prevention of HIV-associated TB. These developments have informed updated recommendations in the related modules on TB screening, prevention, diagnosis and treatment in the WHO consolidated guidelines on tuberculosis on the WHO TB Knowledge Sharing Platform. There have also been updated recommendations within the Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring.
