On Universal Health Coverage Day, The Union calls for TB diagnosis, treatment and prevention for all

On Universal Health Coverage (UHC) Day, 12 December 2019, The Union joins advocates worldwide to demand strong, equitable health systems for all, regardless of their income or location.

At the United Nations High-Level Meeting on UHC on 23 September 2019, world leaders agreed the UN Political Declaration on UHC, the most comprehensive set of high-level health commitments ever adopted, committing to accelerate efforts towards the achievement of UHC by 2030.

As one of the world’s deadliest infectious diseases, tuberculosis (TB) should be a high priority in the global UHC agenda. Ahead of the UN High-Level Meeting on UHC at the 72nd World Health Assembly, The Union read an intervention urging Member States to ensure that the upcoming 2019 political declaration on UHC synergises with previous political declarations on TB and other disease areas:

“With 36 percent of people with TB going undiagnosed, and 90 percent of the children who died from TB last year left untreated, there is no doubt that the goal of UHC goes hand-in-hand with the Sustainable Development Goal to end the global TB epidemic by 2030.”

The ‘universal test and treat’ approach – whereby people in high burden areas are actively offered TB and HIV testing and linkage to care – has been proposed by the public health community as a strategy to achieve steep reductions in HIV and TB in hard-to-reach areas and communities that have been neglected by health systems.

To encourage countries to adopt the ‘universal test and treat’ approach, evidence is needed to prove that it is effective. Results from the large scale PopART intervention – which offered universal testing and treatment for TB and HIV through house-to-house visits across 14 communities in Zambia and South Africa on an annual basis from 2014 to 2018 – showed that this method was successful in reducing rates of HIV infection in these communities.

The TREATS study is now measuring whether the PopART intervention was similarly successful in reducing the prevalence and incidence of TB in the same communities – while also raising awareness of TB and HIV through community engagement and linking anyone who tested positive for TB or HIV to immediate treatment.

Albert, 29, was invited by TREATS community workers to be screened for TB and HIV at a mobile field site in Kanyama, an urban community in Lusaka, Zambia. He was surprised to be diagnosed with TB.

“When I went to the mobile field site I had no knowledge that I had TB because I didn’t have any obvious symptoms that people associate with TB. I was healthy as far as I was concerned. I’m happy that TREATS came to me and advised me to go and get treated. They saved my life.”

Proving the success of PopART in reducing rates of HIV and TB will lead to more high burden countries implementing the ‘universal test and treat’ approach, to ensure that everyone is actively offered TB and HIV screening and a link to care.

TB is exacerbated by many other common health concerns like tobacco and other substance use, diabetes and HIV. Interventions that prioritise comprehensive and integrated treatment for the person seeking care are essential both in achieving UHC and in ending TB.


TREATS (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for Active TB) is measuring the success of a ‘universal test and treat’ project called PopART in reducing the prevalence and incidence of TB in Zambia and South Africa. These findings will help inform new policies and approaches for tackling the TB-HIV epidemic.

TREATS is funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), which is part of the EDCTP2 programme supported by the European Union (grant number RIA2016S-1632-TREATS).

Read more about TREATS.