perspectives on tb/hiv scale- up for the next ten …...perspectives on tb/hiv scale-up for the next...
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Perspectives on TB/HIV Scale-
Up For the Next Ten Years
Amb. Eric Goosby, M.D.
U.S. Global AIDS Coordinator
AIDS 2012 - Turning the Tide Together
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PEPFAR
Estimated number of cases
Estimated number of deaths
1.45 million (range: 1.2–1.6 million)
8.8 million (range: 8.5–9.2 million)
440,000 (range: 390,000–510,000)
All forms of TB
Multidrug-resistant TB (MDR-TB)
HIV-associated TB
1.1 million (13%) (range: 1.0–1.2 million)
350,000 (range: 320,000–390,000)
The Global Burden of TB -2010
about 150,000
Estimated TB incidence rates, by country, 2010
TB cases
per 100 000
0–24
25–49
50–99
100–299
>=300
No estimate
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PEPFAR
• 79% of all TB/HIV cases worldwide are in Africa
• 50% of all TB/HIV cases worldwide are in just 9
Africa countries
• 23% of all HIV-related deaths are due to TB.
• PEPFAR-supported programs as an essential
platform to address TB/HIV
• PEPFAR model of working with national TB and
AIDS programs, diverse partners and multilaterals
Why is TB/HIV a priority for PEPFAR?
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PEPFAR
• More than 13,500 HIV care and treatment
sites, including 5,200 providing ART.
• In 2011:
– 3.9 million PLWH were screened for TB in
HIV care or treatment settings.
– 230,000 PLWH in care started TB treatment
• PEPFAR funding for TB/HIV programs has
increased more than 800% over five years
What is PEPFAR doing in TB/HIV?
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PEPFAR
Xpert MTB/RIF: A Revolution in TB
Diagnosis
• Supporting price
reduction to $9.98 per
cartridge (with
USAID, BMGF, &
Unitaid)
• 136 instruments in
2011
• >100 instruments
planned
• Implementation TA
• Evaluation
Smart investment: “Our analysis showed that Xpert was cost- effective at reducing early
mortality during the first 6 months of ART compared with the current
practice.” (Abimbola et al, JAIDS, 2012)
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PEPFAR
0
50000
100000
150000
200000
250000
300000
350000
400000
�PEPFARTB/HIV patients
�Non-PEPFARTB/HIV patients
�PEPFAR TB/HIVpatients on CPT
"NON-PEPFARTB/HIV
patients on CPT
�PEPFAR TB/HIVpatients on ART
"NON-PEPFARTB/HIV
patients on ART
Pa
tien
t n
um
bers
Coverage of cotrimoxazole and ART among HIV positive TB
patients in PEPFAR and non-PEPFAR funded countries in the
WHO African Region 2003 - 2010
2003
2004
2005
2006
2007
2008
2009
2010
PEPFAR countries reported in African Region (WHO): Angola, Botswana, Cote d'Ivoire, Democratic republic of the Congo, Ethiopia, Ghana, Kenya,
Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe
Non-Pepfar countries reported: Burkina Faso, Burundi, Central African Republic, Congo, Equatorial Guinea, Gambia, Guinea, Guinea-Bissau, Liberia,
Madagascar, Mali, Mauritania, Mauritius, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone
Source:
WHO
Linking HIV+ TB Patients to HIV Care
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PEPFAR
Antiretroviral Treatment: 6 Million People on
ART by End of 2013
PMTCT: 1.5 Million Additional HIV+ Pregnant
Women on ART or Prophylaxis by End of 2013
Male Circumcision: 4.7 Million Additional
VMMCs by End of 2013
New Presidential Targets for HIV/AIDS
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PEPFAR
Scaling ART Positively Impacts Whole Communities
• For every 1000 patient-years of treatment:
– 228 patient deaths averted
– 449 children not orphaned
– 61 sexual transmissions of HIV averted
– 26 vertical (mother-to-child) infections
averted
– 9 TB cases averted among HIV patients
– 2.2 life-years gained
Societal Benefits of ART
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PEPFAR
ART Reduces Mortality and Prevents TB
Incidence
0.60
0.65
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Prob
abilit
y of s
urviv
al (%
)
0 50 100 150 200 250Time from TB treatment initiation (weeks)
Early arm Late arm
Early ART
reduces
mortality
ART reduces TB incidence
ART prevents
TB incidence
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PEPFAR
What must we do more of going
forward? What must we do better?
• AIDS-Free Generation Emphasis Areas for TB/HIV: – Ending HIV associated TB among PLHIV with massive coverage
of ART, IPT and infection control
– Ramping up of ART in TB clinics.
– TB screening and diagnosis in ANC and PMTCT settings
– HIV testing: TB patients’ family members, TB suspects;
– PHDP (positive health, dignity and prevention)
• Greater collaboration between TB and HIV communities
• HIV programs taking greater responsibility for the implementation of TB/HIV collaborative activities
• Increasing engagement with civil society for expertise and greater reach
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PEPFAR
• There is global consensus that controversies
around TB/HIV are largely resolved
• Gaps in policy and guidance are resolved
• Focus now should be on scaling up and
catalyzing implementation
Next Steps
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PEPFAR
Thank You
For further information, please visit:
www.PEPFAR.gov
www.facebook.com/PEPFAR
www.twitter.com/PEPFAR