HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs), a report by the World Health Organisation has revealed.
The report, released recently by WHO, is on high HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB.
WHO recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal.
The annual report on the coverage of HIV testing, yield of HIV, linkage to ART and treatment outcomes among people investigated for TB, would increase the international visibility of this important patient group, encourage national programmes to implement existing international recommendations, and enable progress to be tracked over time.
WHO conducted a systematic literature review and meta-analyses to estimate HIV and TB prevalence, and short-term (two to six months) mortality, among adults with TB symptoms at community- and facility level.
Adults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys.
TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom-based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics.
Interventions to reduce short-term mortality are urgently needed.
The findings from this systematic literature review illustrate the urgent need to improve the management of patients with TB symptoms in high HIV prevalence settings.
HIV prevalence among adults with TB symptoms was high at all levels of healthcare, including in general population surveys, while TB prevalence and mortality risk increased substantially at primary care and hospital level respectively.
The high yield of undiagnosed HIV should make both community‐ and facility‐based TB screening interventions of high interest to HIV programmes trying to reach UNAIDS 90‐90‐90 targets for HIV service coverage.
TB programmes need to develop the necessary partnerships and expertise to ensure that HIV testing is provided alongside all TB screening interventions.
More usable and effective high‐throughput TB screening algorithms are needed at all levels of the health system.
The high risk of early death, most notable for inpatients, but also at primary care is an issue in urgent need of more research and intervention.
HIV associated tuberculosis (TB) morbidity and mortality is a major concern in sub-Saharan Africa.
Understanding the level of HIV infection among TB patients is vital for adequate response.
WHO conducted a systematic review and meta-analysis to estimate the prevalence of HIV in TB patients in sub-Saharan Africa. A meta-analysis with a random-effects model was performed.
Potential sources of heterogeneity in the prevalence estimates were explored using meta-regression analysis. We argue that this is due to strengthened HIV prevention and control response and enhanced TB/HIV collaborative activities.
Countries and regions with high burdens of HIV and TB should strengthen and sustain efforts in order to achieve the goal of ending both HIV and TB epidemics in line with the Sustainable Development Goals.
