By Jennifer Sherwood and Christina Chandra
Just as the world's attention shifted from the worst outbreak of Ebola in history to the rapidly emerging Zika epidemic, another infectious disease silently claimed its place as the world's deadliest: Tuberculosis (TB).
Last year, TB surpassed HIV as the number one infectious killer in the world. In 2014, there were 9.6 million new TB cases and 1.5 million deaths caused by TB. Half a million were diagnosed with multidrug-resistant TB, of which about 10% had extensive drug resistance -- for which even the most potent drugs are ineffective. One need look no further than the global TB pandemic to be reminded of how a curable disease can continue to rage in a climate of feeble health systems and lack of political prioritization.
For people living with HIV, the story is worse. TB is the leading cause of death for people with HIV, accounting for a third of all AIDS-related deaths. The chance of developing TB is also about 30 times higher for people living with HIV than those without. When a major outbreak of multidrug-resistant TB hit a rural South African town in 2005, all of those who developed extensively drug-resistant TB were also living with HIV, complicating treatment and lowering the probability of successful cure. HIV and TB remain inextricably linked.
All of this is not to say that the fight against TB and HIV-TB co-infection has been unsuccessful. Since 1990, TB deaths have fallen by 47%, and between 2000 and 2014, 43 million TB patients were saved due to effective diagnosis and treatment. In 2015, the Millennium Development Goal to halve the prevalence of TB disease and deaths between 1990 and 2015 was met. Collaboration between the HIV and TB communities has led to multiple innovations in research and therapeutics to understand drug interactions and develop treatment guides for HIV-TB co-infected patients. This partnership has been essential to the 34% reduction in TB-related deaths for people living with HIV observed since 2004.
Despite these efforts and notable progress, TB remains on the margins of public awareness and political concern. Advocates applauded the Obama Administration for putting forth a National Action Plan for Combating Multidrug-Resistant Tuberculosis in late 2015, but the Administration simultaneously proposed a $45 million cut to USAID TB programs. The lofty goals of the national plan - such as strengthening domestic and international capacity and accelerating research and development to combat multidrug-resistant TB -- cannot be met without sufficient financing.
Looking ahead, the global goals of eliminating TB and ending AIDS are ambitious. By 2020, both TB and HIV have global 90-90-90 targets. For TB, this means 90% of people on treatment, 90% of those most vulnerable to TB infection reached with services and 90% of patients successfully treated. For HIV, these targets mean 90% diagnosed, 90% on treatment and 90% virally suppressed. By 2030, the Sustainable Development Goals set a target of ending the TB and AIDS epidemics altogether. The obstacles to achieving these goals are similar for both diseases: weak health systems, underlying social determinants, lack of effective tools and unmet funding needs. To meet these challenges, diseases can no longer be viewed in silos. The world requires a systems approach to combatting diseases as opposed to singular disease interventions.
In the words of World Bank President Dr. Jim Kim at USAID's World TB Day commemoration this month, "TB is not on my agenda." Rather, Dr. Kim proposed integrating TB interests into broader global goals, such as universal health coverage and global health security, is now key to global health advocacy. Despite the obstacles, Dr. Kim's words were hopeful, and HIV and TB advocates are optimistic that with the appropriate resources, they can overcome these barriers, and end the unnecessary suffering caused by HIV/AIDS and TB.
Last week we observed World TB Day with the theme "Unite to End TB." HIV/AIDS and TB researchers, scientists and advocates once came together to solve the riddles of co-infection. As a global health community, we now have another opportunity to unite around global goals to build better health systems and eliminate the most dangerous infectious diseases of our time. Beyond World TB Day, HIV/AIDS advocates can show solidarity with the fight against TB by working together to achieve common goals for a healthier, disease-free world.
Jennifer Sherwood is a Policy Associate at amfAR, The Foundation for AIDS Research.
Christina Chandra is an Allan Rosenfield Public Policy Fellow at amfAR, The Foundation for AIDS Research.