TB and HIV in Africa
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
International Development Minister Stephen O’Brien’s speech to the All Party Parliamentary Group on Global Tuberculosis meeting on TB and HIV in Africa, Tuesday 22 March 2011 I would like to thank the APPG for organising this event and for their review, which the Government welcomes.
I think it makes a compelling case for action. We need to make still greater progress against HIV and TB co-infection - and the double cruelty it can represent.
Every year there are 9 million new cases of TB, including one million cases amongst people living with HIV. Alarmingly, we are seeing half a million cases of multi-drug resistant TB. And every year there are nearly 2 million deaths.
Likewise, AIDS is one of the leading causes of death of women of reproductive age globally and there are still more than 7,400 new infections every day. 10 million people are not getting the treatment they need. Only 140,000 TB patients living with HIV received ART in 2009.
We have made progress on both these fronts. Incidence of TB has been declining slowly since a peak in 2004, and there is an 86% treatment success rate when the WHO recommended approach is used. HIV infection rates are also levelling off globally, with over 5 million people now accessing AIDS treatment, which is a 10-fold increase over five years.
Front line challenges for tackling TB include drug resistance and the need for more research and better drugs and diagnostics. On the HIV side, we need to scale up successes in prevention and find sustainable ways meet the need for treatment, care and support in an accessible and affordable way.
These challenges are compounded by co-infection. Tuberculosis is the leading cause of death among HIV infected people. In 2009, cases of co-infection accounted for 23% of all TB deaths and 22% of all deaths among people living with HIV. Nelson Mandela made it clear back in 2004: “We can’t fight HIV unless we do much more to fight TB.”
As is so often the case, people in Africa bear the brunt of both diseases, as is also too often the case, a double dose of stigma and discrimination as well, which in turn inhibits people getting tested and seeking help. But both TB and HIV are global problems, and both disproportionately affect the most vulnerable and marginalised of society. For example, TB amongst injecting drug users, or prisoners, in the concentrated HIV epidemics is of particular concern.
That is the problem. What are we going to do about it?
I am proud to serve in a Coalition Government that, even in tough times, has protected the aid budget and the pledge to reach the target of 0.7% of Gross National Income spent on development. I’m also proud to serve in a Parliament where we have cross-party consensus that this is the right thing to do. Our Secretary of State has said we will not balance the budget on the backs of the worlds poorest. That includes those living with HIV and TB.
We are equally clear about the responsibility that comes with these resources, the responsibility to spend taxpayers’ money well; to deliver aid that is accounted for transparently; to ensure our support delivers value for money and gets where it is most needed.
That is why on 1 March we published ‘UK Aid – Changing Lives, Delivering Results’- setting out the results of our Multilateral and Bilateral Aid Reviews, which we commissioned immediately after we took office.
This document builds on our commitment to put the health of women and girls front and centre of our development effort – and, specifically, to scale up improvements in the areas of reproductive, maternal and newborn health and malaria. The results we will deliver in these two areas are set out in two Frameworks for Results, published in December.
The results as summarised in ‘UK Aid – Changing Lives, Delivering Results’ are necessarily high-level. The detail will follow as DFID country offices develop their operational plans for taking results forward. We have also committed to set out our objectives on HIV and TB by May.
But I can tell you today we remain committed to the global goal of halving deaths from TB by 2015 through delivery of the revised Global Plan to Stop TB. And to the goal, which was reiterated at Muskoka, to come as close as possible to universal access to HIV prevention, AIDS treatment care and support.
To address TB- HIV co-infection, I think we need to drive forward progress in three areas:
The first is to increase access to and use of effective diagnosis and treatment of TB, including TB-HIV co-infection. DFID will do this through our bilateral and multilateral support, as well as through our investment in research and product development into more effective treatment and vaccines.
DFID invested £10.7 million on TB-related research through our bilateral research programme alone in 2009/10. UK government research support includes a focus on developing drugs and vaccines for HIV and AIDS, TB and malaria and other diseases that most affect poor people.
We support TB research through multilateral and bilateral research programmes – for instance the Tropical Disease Research special programme to gain better evidence about how to best combine therapy for HIV and TB co-infection, which is receiving £14 million UK government funding for 2008-13. The government is also providing £20.5 million for 2008-13 to the Global Alliance for TB Drug Development, which has the largest single portfolio of potential TB compounds ever assembled, with two drugs in late stage clinical development.
The TB Alliance is developing new drugs which can be used by people who are also infected with HIV with minimal drug-drug interaction for people and who are on anti-retroviral treatment. The Alliance is also developing novel methods to test combinations of new TB drugs, rather than testing each drug individually. They have identified a few regimens that are better than standard therapy and should be active in treating drug resistant TB.
The first clinical trial to test multiple new TB drugs was launched in November 2010 and the preliminary results are expected later this year. They offer promise in treating both drug-sensitive and drug-resistant TB, potentially making scale-up of Multi-Drug Resistant treatment worldwide much cheaper and easier than anything available to date.
A new, improved TB vaccine is an essential part of the global strategy to curb the epidemic of TB and TB/HIV co-infection and disease. DFID is supporting Aeras and its partners (with £10.5m for 2009-2014) to test vaccines to see if they are safe and effective in preventing TB in HIV positive people.
So I’m delighted that this year’s World TB Day focuses on innovation in research and delivery. This Government is committed to finding innovative solutions to challenges in development, including harnessing the creative energy of the private sector.
Secondly, we need to support health systems, including in particular, the integration of HIV and TB services. Coordination between the services for the two diseases is improving, but much remains to be done. Improvements in prevention and treatment of HIV and AIDS will benefit TB control. We will continue to focus on both HIV and TB, and on strengthening the underlying health systems in order to improve the way health services diagnose and treat illnesses, including TB and TB-HIV.
Strengthening health systems in DFID partner countries helps to support and deliver TB programmes by building the long term capacity across health services in partner countries to enable them to identify and address TB, especially in poor areas. We do this through supporting national health plans directly or through support to multilateral organisations such as the World Bank.
Finally we need to address the underlying poverty and social drivers that put people at risk of infection and once infected of becoming sick: poor housing, poor working conditions, drug use and poor nutrition. Integration of nutritional support with HIV services is also essential. We also need to address the factors that make people, and women in particular, vulnerable to HIV, including harmful gender norms and gender based violence.
We are already contributing to this agenda in a number of countries.
For example, DFID is working with the Government of South Africa to expand the quality and access of public sector services including tuberculosis control, and increasing the speed with which new ART/-TB drugs get registered as they become available elsewhere. In South Africa, reducing the levels of HIV and improving the quality and reach of public health services are key objectives of DFID support. They are central to reducing the burden of TB in the country Our support for the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria will also be important to reaching a range of countries most in need.
In the Multilateral Aid Review, the Global Fund was assessed as providing very good value for money for UK Aid. Our future funding will still be conditional; we want to see evidence of progress against a suite of reforms designed to improve the way the Fund does business and maximise its impact, and we want to see these reforms implemented with pace and urgency. The UK will also encourage other partners to meet their commitments to the Fund.
The UK government has made a 20-year commitment to UNITAID of up to €60 million per year. UNITAID aims to triple access to rapid test for multi-drug resistant TB and reduce the price of drug resistant TB medicines by twenty-five percent.
I see our partnership with civil society as the final piece of the jigsaw. The commitment of people in this room to keeping both HIV and TB high on the international agenda is invaluable. It would be all to easy to say that the progress we have made is the best that can be achieved; that it is time to turn to other priorities. Instead, in partnership, let us finish what we have begun.