World AIDS Day: Ending the TB-HIV epidemic

There are 35.3 million people living with HIV in the world, of these one-third are also infected with mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB) disease.

In 2017, 1.6 million people died of TB. For people living with HIV, TB is the most significant co-infection – 40 percent of HIV deaths in 2017 were due to TB. Therefore, it is clear to see that TB and HIV are inextricably intertwined.

Today on World AIDS Day (1 December), we highlight the work of a project – which The Union is a partner of – measuring the impact of a household-level combined HIV and TB prevention intervention on the burden of TB at population level in South Africa and Zambia.

The Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening for active TB (TREATS) project came about as part of the largest ever trial of a combination HIV prevention strategy. This trial, called HPTN071 or Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART), is being conducted across 21 communities in Zambia and South Africa, covering around one million people in total.

PopART involved universal testing and treatment (UTT) for HIV through house-to-house visits on an annual basis over four years – from 2014 to 2018. As part of this trial, all members of these communities are also screened for TB.

As Dr Helen Ayles, project director of TREATS explains, this is where TREATS came in:

“The scale of PopART meant that we were testing every member of the population for HIV, as well as screening every member of the population for TB. It was true active case finding.

“Establishing the TREATS project was so important as it allows us, for the very first time, to measure the effect of a combination TB and HIV intervention delivered to the entire population in seven urban, high prevalence communities, and to compare this with seven matched communities that did not receive this intervention.”

The main results from PopART, the effect on reducing new cases of HIV in the population, will be released in March 2019.

Helen added: “For me personally, the TREATS project brings together 20 years of research into a combined strategy – to end both TB and HIV at community level. It is a unique opportunity to assess an intervention on a massive scale. The TREATS consortium brings together a fantastic team of some of the best TB researchers and modellers, TB diagnostics companies and communications experts in TB. The study, I am sure, will involve many challenges. But it will also provide amazing data, and hopefully practical solutions to end TB.”

The TREATS consortium is made up of:

  • London School of Hygiene & Tropical Medicine
  • Imperial College London
  • University of Sheffield
  • KNCV Tuberculosis Foundation
  • Zambart
  • The Health Systems Trust
  • International Union Against Tuberculosis and Lung Disease
  • Delft Imaging Systems