It's time for action on inequality to end TB and AIDS

As we mark this year's World AIDS Day and focus on ending inequalities, we need to remember that TB is a leading cause of death among people with HIV and the second most common cause of death from an infectious disease, after COVID-19. TB is driven by poverty and thrives on inequity, disproportionately affecting the most vulnerable and marginalized. The COVID-19 pandemic is further fuelling inequality by driving up poverty and malnutrition, both of which are major risk factors for TB. Access to essential services for TB has also been severely hampered due to COVID-19 related restrictions and the redirection of resources to the COVID-19 response.

At the fifth United Nations High-Level Meeting (UNHLM) on HIV and AIDS held earlier this year, WHO hosted a high-level side event entitled "Ending TB deaths among people with HIV: Step up the Momentum" to highlight the need for increased and sustained commitment to end TB deaths in people living with HIV. At this UNHLM, Member States committed to reducing TB deaths in people with HIV by 80% by 2025, compared to 2010 and to providing 90% of people with HIV with TB preventive treatment by 2025.

Whilst the last decade has seen an average annual reduction of 10% in TB/HIV deaths, the COVID-19 pandemic has reversed this trend, with an increased number of deaths in 2020, compared with 2019. Less than half of the people estimated to have HIV-associated TB were diagnosed and notified in 2020. TB preventive treatment among people with HIV has seen an impressive scale-up over the past few years, achieving more than the 6 million milestone target set at the 2018 UN High-Level Meeting on TB, 2 years in advance. However, still not all in need have access to TB preventive treatment, including among people with HIV and especially among household contacts of people with confirmed TB disease.

Yet we have the tools to address TB and HIV, and technologies are advancing. Over the last year WHO has released several guidelines to improve TB services for people with HIV. We need to ensure rapid uptake and facilitate access to these tools and treatments, ensuring that our services reach the most vulnerable especially considering the challenges to health system due to the ongoing pandemic.

We should also learn from the COVID-19 response, which has shown us that it is possible to rapidly scale up technologies to fight communicable diseases, with political will and multisectoral collaboration. We need to leverage these lessons and innovations to galvanise our efforts towards equitable, universal and timely access to TB screening, diagnosis and treatment with the latest available technologies. It will be critical in our collective efforts to regain the ground that we have lost to COVID-19 and to ensure that we leave no one behind.

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