TB/HIV Research Priorities in Resource-Limited Settings
Expert Consultation, WHO, Geneva, 14-15 February 2005
Background
HIV is the main reason for failure to meet Tuberculosis (TB) control targets in high HIV settings. TB is a major cause of death among people living with HIV/AIDS. Sub-Saharan Africa bears the brunt of the HIV-fuelled TB epidemic. The rapidly increasing HIV epidemic in East European countries and China could also increase the number of HIV-related TB cases. In response to this, the Stop TB Partnership, through the TB/HIV Working Group, has coordinated the global response that has resulted in the interim policy on collaborative TB/HIV activities document (WHO/HTM/TB/2004.330, WHO/HTM/HIV/2004.1) and the minimum package of guidelines to address the TB/HIV epidemic.
The increasing international commitment to improve access to treatment of people living with HIV/AIDS accrues its benefits to HIV-infected TB patients. One in five patients targeted for several international initiatives (the 3 by 5 Initiative, the "President's Emergency Plan for AIDS Relief " and the Global Fund, among others) will be HIV-positive TB patients. HIV-infected TB patients should not have to die of AIDS. Likewise, the emerging HIV delivery services should identify TB suspects and refer them for sputum testing so as to provide optimal patient-centred care.
In 1995, WHO convened a meeting to establish TB/HIV research priorities and to develop a coordinated approach for these research activities. However, in the context of current scale up of antiretroviral treatment in resource poor settings, the challenge of implementing the TB/HIV interim policy calls for an updated approach to operational research specifically aimed at informing policy. TB/HIV operational research should address short and medium term questions that are useful for improving TB and HIV control. This will be done in the context of the WHO HIV/AIDS and TB research strategy and it will then be transferred into more efficient programme activities. The TB/HIV research priorities areas, as they appear in the agenda, have been identified at the 3rd and 4th TB/HIV Working Group meetings, in June 2003 and September 2004, respectively. Furthermore, issues related with how to implement the TB/HIV package will be discussed. The process to develop TB/HIV research priorities will be rooted in national and local experience, but can be applied at the global, national, or community level.
The TB/HIV Working Group Secretariat of the Stop TB Partnership in collaboration with the WHO's Stop TB and HIV/AIDS departments and the UNDP/UNICEF/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) are convening an expert consultation to help define the TB/HIV research priorities and propose approaches to implementing it in the context of ART scale-up and implementation of the TB/HIV interim policy.
Collaboration of partners at global and country level needs to be maximised to accelerate the implementation of collaborative TB/HIV activities.
For any further information please Email: tuberculosis@who.int and place in the subject box: "For the attention of Dr Fabio Scano"