USAID Programs: Tuberculosis and HIV/AIDS

HIV/AIDS and TB are the two biggest infectious killers in the world today:

• Each year, HIV/AIDS is responsible for over 3 million deaths, and TB for 2 million.
• 42 million people in the world are infected with HIV, and 2 billion are infected with TB.
• Almost one-third of HIV-infected individuals are also infected with TB.

HIV infection accelerates the progression of TB infection to active tuberculosis; people with both HIV and TB infection are 30 times more likely to get active TB. In addition, recent studies have shown that TB infection may accelerate the progression of HIV infection to AIDS.

The dual epidemics of TB and HIV/AIDS are particularly pervasive in Africa, where more than 50 percent of individuals with active TB disease are also HIV-positive. The dual epidemics are also of growing concern in Asia, which is home to two-thirds of the world's TB-infected, and where TB accounts for 40 percent of AIDS deaths. In the former Soviet states, the HIV/AIDS epidemic is growing at the same time as TB.

Fortunately, TB treatment is just as effective for people infected with HIV/AIDS as it is for people who are HIV-negative. Studies have shown that prophylaxis with anti-TB drugs can decrease the likelihood that TB infection will progress to active TB in patients with HIV.

USAID's Approach

USAID TB and HIV/AIDS programs aim to improve the coordination of TB and HIV/AIDS services, increasing access to TB testing and treatment for people living with HIV/AIDS, and increasing access to voluntary HIV counseling and testing and other HIV/AIDS services for those infected with TB. USAID's earliest TB activities were part of the agency's HIV/AIDS efforts and focused on community-based care of TB patients in areas where high HIV infection rates had fueled TB epidemics. These pilot projects proved successful, and they are currently being replicated and expanded. With the launch of USAID's infectious diseases strategy in 1998, USAID's TB activities expanded dramatically. Partnerships with other donors, organizations, and institutions were created in an effort to strengthen and expand national programs, improve surveillance, and develop preventive, diagnostic, and treatment alternatives.

USAID TB HIV Programs

• In response to the growing problem of tuberculosis and HIV co-infection, USAID is looking for ways to provide more accessible services for people with co-infections. USAID is supporting WHO's "ProTEST" Initiative, which aims to deliver coordinated interventions for tuberculosis and HIV prevention and care. "ProTEST" uses voluntary counseling and testing as an entry point for access to a variety of HIV and tuberculosis interventions. Pilot project sites in South Africa, Malawi, and Zambia have served more than 70,000 individuals over the past six years.
  
• USAID has been supporting community tuberculosis treatment services in Malawi and Uganda, two countries with high HIV prevalence. Malawi has already attained countrywide coverage, while Uganda is implementing services in 24 of 56 districts with plans for national coverage within two years. USAID is supporting the expansion of this approach in other African countries.
  
• A USAID-supported study in Thailand tested an intervention to help caregivers correctly identify and manage opportunistic infections in HIV/AIDS patients. The intervention developed manuals for caregivers, which are now being translated for use in Indonesia, China, and Latin America.
  
• Operations research to test model approaches for providing TB/HIV care using Directly Observed Treatment, Short-Course (DOTS) programs as the entry point to services.

Future Directions

Increased collaboration of national TB and AIDS control programs in prevention, diagnosis and treatment is essential to improve the health and well-being of individuals infected with TB and HIV. USAID will continue to work to ensure stronger partnerships at the country and global level.

• President’s Emergency Plan for AIDS Relief HIV/TB Fact Sheet, July 2006 [PDF, 454KB]