Tuberculosis Co-Infection with HIV Responds to Concurrent Treatment

In 2014, USAID funded MEASURE Evaluation to initiate an impact evaluation in Ukraine for two TB programmatic priorities: (1) improving integration of TB and HIV services to reduce mortality through early diagnosis and treatment for co-infected patients; and (2) providing social support services to improve TB treatment adherence.

By Martha P. Skiles, MPH, PhD and Stephanie Mullen, DrPH, MEASURE Evaluation

On World Tuberculosis Day (March 24), it’s timely to note that current data from Ukraine are showing promise in reducing the likelihood of death among patients that are co-infected with TB and HIV, if they are receiving concurrent treatment for both diseases (see Figure 1).

TB Figure
Figure 1: Time to death among co-infected TB-HIV patients, by ART status

Although tuberculosis (TB) is a curable disease, it has devastating consequences on public health, second only to the human immunodeficiency virus (HIV) in the number of deaths caused by an infectious disease worldwide. The World Health Organization (WHO) estimates that nine million people developed TB in 2013 and 1.5 million died of TB-related causes globally. It also estimated that of the nine million with TB, three million people were either not diagnosed, or were diagnosed but not reported to the national TB program, and 1.1 million of them were co-infected with HIV. Testing for HIV is critical to identify and treat co-infected people. However, in 2013 just less than half of TB patients had a documented HIV test result. Multidrug-resistant TB (MDR-TB) affected an estimated 300,000 people in 2013, but only 136,000 cases were diagnosed and reported.

Ukraine is a WHO priority country for TB control and has among the highest drug-resistant TB burdens in the world. USAID-supported projects have focused on expanding availability and improving the quality of services to ensure adherence to appropriate treatment for TB patients, while concurrently working at the policy level to reduce barriers to accessing high quality case detection and treatment. 

In 2014, USAID funded MEASURE Evaluation to initiate an impact evaluation in Ukraine for two TB programmatic priorities: (1) improving integration of TB and HIV services to reduce mortality through early diagnosis and treatment for co-infected patients; and (2) providing social support services to improve TB treatment adherence.

“HIV and TB have formed a deadly alliance,” says Jim Thomas, MPH, PhD, Project Director of MEASURE Evaluation, implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill. “When paired, each makes the other more lethal. Immediate initiation of ART is the universal recommendation for anyone co-infected with TB and HIV. This study adds to growing evidence that simultaneous treatment for TB and HIV substantially reduces mortality among the co-infected.”

In the study of TB and HIV service integration, data reviewed from patients presenting with TB found that early initiation of antiretroviral treatment (ART) for those co-infected with HIV, improved survival.  Among these co-infected patients, uptake of ART was associated with an approximate 75% reduction in the likelihood of death (Figure 1) from any cause over the approximately two-year treatment window. 

In a companion study measuring the effect of social support services on TB treatment outcomes, the retrospective baseline analysis of health facility and program records for 2012 suggest the social support program succeeded in retaining the most-at-risk TB patients in treatment. However some patients at risk for treatment default were found to have been less likely to receive the social support services, indicating there is a need to improve program targeting of those services to reach more of those at risk for default.

Read more on the study.

This article is reprinted from Science Speaks.

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