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World Tuberculosis Day: Fighting the TB/HIV Epidemics Through PEPFAR


Today, we join the international community in recognizing World Tuberculosis (TB) Day. Addressing TB is a major part of the work of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), as TB is the most common opportunistic infection and the leading cause of death among people living with HIV in sub-Saharan Africa. In 2009, the World Health Organization (WHO) estimated that of the 9.4 million cases of TB worldwide, 1.1 million of these individuals were also infected with HIV. Nearly 80 percent of TB/HIV co-infections are found in the Africa region, and PEPFAR has invested heavily in hard-hit countries.

With support from PEPFAR, countries have made extensive strides in expanding the number of TB patients also tested for HIV, and enrolling HIV-infected TB patients into HIV care and treatment. In FY 2009, PEPFAR provided direct support to care for more than 308,700 TB/HIV co-infected people in PEPFAR countries, mostly in Africa. Moreover, with support through PEPFAR, 53 percent of TB patients in Africa knew their HIV status, and an estimated 140,000 TB/HIV patients were on antiretroviral treatment.

Other recent developments give me optimism about our international partnerships to address TB/HIV in the future. First, I am pleased to announce that PEPFAR will provide $20 million in special one-time funding to develop and initiate an innovative, integrated TB/HIV care package in targeted countries with a significant burden of TB/HIV co-infection. Overall, PEPFAR will provide $160 million in resources to combat TB/HIV, funds that complement broader PEPFAR investments to benefit co-infected populations.

In addition to reaching and identifying people infected with TB, we are also heavily involved in expanding access to HIV care and antiretroviral treatment for all eligible HIV-positive patients, including people co-infected with TB. Through our prevention work, PEPFAR is protecting patients, staff of healthcare facilities and communities through improved infection control and increasing the use of isoniazid preventive therapy, which helps prevent TB infection in people living with HIV. Meanwhile, we are increasing laboratory capacity and supporting new diagnostic technologies that will assist us in identifying, treating, and preventing TB and HIV.

I am optimistic about WHO's recently endorsed rapid test for tuberculosis. The Xpert MTB/RIF test will improve the way TB is diagnosed and is superior to older, much slower TB tests. With the Xpert MTB/RIF rapid diagnostic test, we will be able to quickly and reliably detect TB and identify drug resistance to rifampicin, start appropriate treatment, and ultimately reduce TB transmission. Cost-effectiveness data are promising and this technology could be an example of a smart investment that will help us become more effective in our mission to save lives. PEPFAR is committed to working with other partners to support the scale-up, appropriate use and evaluation of this new technology. To this end, $2 million in central resources will be made available, pending Congressional approval, to support implementation evaluation, coordination with WHO, and scale-up of this new technology, building upon existing PEPFAR-supported laboratory platforms.

Recognizing the global burden of TB, tackling TB is also a key component of President Obama's Global Health Initiative (GHI), which seeks to improve coordination and collaboration among our U.S.-supported global health efforts. Going forward, we anticipate intensifying collaborations with Ministries of Health and other partners to address TB, HIV and other health challenges. On this World TB Day, we reflect on the promising accomplishments to date, and we join in Secretary Clinton's call on the global community to re-commit ourselves to addressing the challenges of TB.