Tuberculosis is the leading cause of death among people living with HIV. In
2018 an estimated 251,000 people with HIV died of TB — **one third of all
HIV-related deaths and one sixth of all TB deaths.**
There is a preventive treatment, it works independently of antiretroviral
therapy, and in 2017 **fewer than 1 million of an estimated 21.3 million ART
patients worldwide started it.**
In September 2018 the UN General Assembly's first high-level meeting on TB
committed to providing preventive treatment to 30 million people by 2022,
and the United States committed to **all 13.6 million PEPFAR-supported ART
patients by 2021.** This report covers the two years before that, across **16
countries holding roughly 90% of PEPFAR-supported ART patients.**
The two numbers, and why they differ
| Change | |
|---|---|
| TB symptom screening (Apr 2017 → Sep 2018) | 54% → 84% |
| Treatment initiations per reporting period | +32% |
| Treatment completions | +56% |
| Completion rate among those who started | 55% → 66% |
Nearly 2 million ART patients started preventive treatment, and **60%
completed it.**
The first three rows are a programme succeeding. The fourth is the one that
decides how many lives are saved — because **most patients are treated with
six months of daily isoniazid**, and a course abandoned in month three is
mostly cost without protection.
Screening from 54% to 84% and starts up by nearly a third represent things a
clinic can do at a single visit. Completion is six months of daily tablets by
somebody who is not ill, which is a different problem and moved by eleven
points.
Who it is for
The World Health Organization recommends it for people living with HIV
without active TB disease — meaning:
- Adults with a negative screen for **cough, fever, night sweats or weight
loss** - Children with a negative screen for **cough, fever, contact with a person
with TB, or poor weight gain**
and either no tuberculin skin test result at all, or a **known positive
one**. Not having been tested is not a reason to wait, which is what makes the
symptom screen the gateway and explains why screening coverage was the first
thing to move.
What would have to happen next
**TB preventive treatment expansion could save hundreds of thousands of lives
annually**, and the report is specific about what that requires of every
PEPFAR-supported country:
- Estimate the eligible population — you cannot report coverage against an
unknown denominator - Identify barriers to initiation and completion — and after these two
years, completion is the binding one - Improve data monitoring and reporting
**In addition to continuing gains in initiation, improving retention after
initiation is important** — which is the whole finding in one sentence.
Source: Centers for Disease Control and Prevention, MMWR.
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