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WHO recommends new guidelines to address HIV-related TB

Mar 20, 2012

Ahead of the World TB Day, the World Health Organisation has launched its updated policy on collaborative TB/HIV activities that offers guidelines for national programmes and other stakeholders to reduce TB deaths for people living with HIV.

Geneva, Switzerland: Following on from the success of the Interim Policy published in 2004, WHO has launched its revised policy on collaborative TB/HIV activities on March 5, 2012. The new policy is based on the latest scientific evidence generated from randomised controlled trials and observational studies in the field of TB and HIV and country experiences implementing the Interim Policy.

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The Interim policy provided a highly effective framework for implementing partners and donors to focus their resources. More than 100 countries fully adopted the Interim Policy, measured by HIV testing of at least half of TB patients identified and it is estimated that 910,000 lives have been saved globally.

The increased uptake of the interim policy has resulted in more than 60% of the total number of TB patients estimated to have HIV were diagnosed and registered in HIV care in 2010, compared with less than 15% in 2005.
TB screening among people living with HIV increased 12-fold from 200,000 in 2005 to 2.3 million in 2010. The number of people living with HIV without active TB receiving isoniazid-preventive therapy increased from 26,000 in 2005 to
180, 000 in 2010.

The new policy emphasises the importance of establishing mechanisms for the delivery of integrated TB and HIV services at the same place and time, as well as promoting integration within other health programmes such as maternal and child health, and harm reduction services.
The update is a compilation of existing WHO guidelines for addressing HIV-related TB. It also includes extensive reviews of the evidence on key questions such as the benefits of HIV testing in patients with presumptive or diagnosed TB, and their partners and families; co-trimoxazole preventive therapy for TB patients living with HIV; earlier initiation of ART at CD4 count higher than 350 cells/mm3 for TB prevention; and models of integrated TB and HIV services.

Implementation of this revised policy will enable us to make major advances in our efforts to overcome HIV and TB epidemics as set out in the Global Plan to Stop TB and the Global health sector strategy on HIV/AIDS, 2011-2015.

The updated WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders , in contrast to the 2004 policy, recommends offering routine HIV testing to patients with presumptive or diagnosed TB as well as to their partners and family members as a means of reducing the burden of HIV.

TB patients who are found to be HIV-positive should be provided with co-trimoxazole preventive therapy (CPT). Antiretroviral treatment (ART) should be given to all HIV-positive TB patients as soon as possible within the first 8 weeks of commencing antituberculosis treatment, regardless of their CD4 cell-counts. Those HIV-positive TB patients with profound immunosuppression (e.g. CD4 counts less than 50 cells cells/mm3) should receive ART immediately within the first 2 weeks of initiating TB treatment. TB patients, their family and community members should be provided with HIV prevention services.

HIV programmes and TB-control programmes should collaborate with other programmes to ensure access to integrated and quality-assured services for women, children, prisoners and for people who use drugs; this population should also receive harm-reduction services including drug dependence treatment in in-patient and out-patient settings.

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