January 2010 – Despite being curable, Tuberculosis (TB) continues to be the leading cause of death among people with HIV in 2008, accounting for 25% of all HIV-related deaths. The World Health Organization (WHO) has developed a 12-point policy package and recommended collaborative activities to address the TB/HIV coepidemic. The WHO recommends activities to address TB/HIV coinfection, include establishing mechanisms of collaboration between TB and AIDS programs, activities to reduce the burden of HIV in TB patients, and a set of activities that are to be led by national AIDS programs (NAPs) to reduce the burden of TB among people with HIV. The WHO recommends activities that should be implemented by AIDS programs encompass three interventions jointly known as the “Three I’s”: intensified TB case finding (ICF) among people with HIV, TB infection control (IC), and isoniazid preventive therapy (IPT).

Despite the strides in the scale-up of antiretroviral therapy (ART) to reach more than four million people at the end of 2008, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that only 42% of people in need are getting access to HIV treatment. As the WHO guidelines for ART eligibility were revised upward in 2009 from a CD4 cell count of 200 to 350, the number of people who are eligible for ART but are unable to access it has increased, In light of this fact, there is urgent need to scale up all programs that can keep people with HIV healthy even as we advocate for the expedited rollout of ART to achieve universal access. Implementing all of the WHO’s recommended TB/HIV collaborative policies can significantly contribute to reducing disease and death among people with HIV. Despite this, the NAPs have not demonstrated leadership in integrating the Three I’s into services that are offered to people with HIV. The 2009 WHO report shows that of all of the recommended TB/HIV collaborative activities, the Three I’s were the least implemented of all interventions. In 2008 only 1.6 million of the estimated 33 million people with HIV were screened for TB, and less than 1% of the estimated number of people coinfected with TB/HIV were given access to IPT; data on IC was not reported.

In order to assist in advocacy toward the uptake of the Three I’s and to streamline the monitoring of TB/HIV collaborative services, the TB and HIV departments of the WHO, along with UNAIDS; the Global Fund for AIDS, TB, and Malaria (GFATM); and the U.S. President’s Plan for AIDS Relief (PEPFAR) have come together to agree upon 13 monitoring indicators that all of them will use to track the Three I’s. As part of this strategy, the UNAIDS United Nations General Assembly Special Session on HIV/AIDS (UNGASS) shadow reports that track compliance with the Declaration of Commitment to universal access to HIV are also required to report on the 13 TB/HIV indicators.