1. Colleen Daniels Stop TB Department World Health Organisation TB, HIV and Drug Use The overview

2. TB is caused by infection with a bacteria –Mycobacterium tuberculosis It is spread like the common cold through respiratory droplets in the air –Coughing, sneezing, talking, singing… 1/3 of the world’s population are infected with TB (not active disease) Bacteria lives dormant in the lung – latent TB infection Only 5-10% actually develop TB disease during their lifetime (if HIV negative) If HIV positive this increases to 10% every year What is Tuberculosis (TB)?

3. What is HIV/TB? One third of the 33 million people living with HIV is co-infected with TB TB is a leading cause of death among people living with HIV The majority of cases of tuberculosis in people living with HIV, occur in sub-Saharan Africa, where up to 80% of TB patients may be co-infected with HIV Also very high levels of co-infection in certain high risk groups

4. Global Burden of HIV/TB/IDU 2008 HIV 33.2 million people living with HIV 2.5 million new infections 2.1 million people died of AIDS (AIDS Epidemic Update 2009) Tuberculosis 9.4 million new cases 1.3 million people died of TB An additional 0.5 million HIV deaths due to TB (WHO- Update Global TB Control 2009) IDU 15.9 million people who inject drugs 3 million HIV positive Eastern Euro – 57% new HIV infections among IDUs (AIDS Epidemic Update 2009)

5. TB, HIV and injecting drug use - Overlap TB HIV 15.9 million 9.3 million ? million ? Injecting Drug Use 3 million 1.4 million33.3 million People who use drugs have 10-30% increased risk of getting TB

6. Vulnerable groups Substance users –Injecting drug users –Other drug users –Alcohol excess –Smoking Migrant populations –Economic –Social Refugees Children/young people Prisoners Indigenous populations

7. Global response in 2008 1.4 million HIV positive TB cases –500,000 people died of HIV associated TB Only 1.4 million TB patients (out of 9m) tested for HIV –Of those HIV positive; 200,000 given CPT and 100,000 ART Only 1.4 million PLHIV (out of 33.3m) screened for TB –Only 48,000 given IPT 8 out of every 100 IDUs received OST

8. Collaborative TB/HIV activities A. Establish the mechanism for collaboration A.1. TB/HIV coordinating bodies A.2. HIV surveillance among TB patient A.3. TB/HIV planning A.4. TB/HIV monitoring and evaluation B. To decrease the burden of TB in PLWHA B.1. Intensified TB case finding B.2. Isoniazid preventive therapy B.3. TB infection control C. To decrease the burden of HIV in TB patients C.1. HIV testing and counselling C.2. HIV preventive methods C.3. Cotrimoxazole preventive therapy C.4. HIV/AIDS care and support C.5. Antiretroviral therapy to TB patients.

9. HIV HIV epidemic began 25 years ago History of strong political advocacy/activism Strong global awareness Rapid test on finger prick or saliva in minutes, simple and accurate Dozens of new drugs to treat HIV TB TB thousands of years old Recent adoption of advocacy/activism TB a forgotten disease Diagnostic test more than 120 years old, tedious & inaccurate No new TB drugs for >40 years Power of advocacy No more people living with HIV, dying of TB!

10. Barriers Advocacy/activism Inadequate tools/lack of research Weak health systems – human resources Lack of collaboration and poor integration at patient level No integration with harm reduction programs –No provision OST Poor implementation of the Three I’s Lack of social mobilization HIV continues to spread

11. Summary TB, HIV and drug use closely linked TB is preventable & curable in people living with HIV & drug users Universal access means access to comprehensive TB and HIV prevention, care and treatment linked to services for people who use drugs All stakeholders in TB, HIV and drug use need to work closely together to reduce the interrelated impact