The 2nd Meeting of the Global Working Group on TB/HIV Durban, June 14-16, 2002 Progress 2001-2002

1. The 2nd Meeting of the Global Working Group on TB/HIVDurban, June 14-16, 2002Progress 2001-2002 Paul Nunn, STOP TB WHO, Geneva

2. Contents • Summary of the state of the epidemic • Recommendations and practical results • Review of the environment • Future directions

3. 500 450 Zimbabwe 400 350 300 250 Malawi Rate (x100,000) 200 Kenya Tanzania 150 Côte d'Ivoire 100 50 0 1980 1985 1990 1995 2000 Years Africa: HIV is driving the TB Epidemic TB Notification Rates, 1980-1999 World Health Organization

4. Summary HIV/TB - 2000 L Corbett et al. Arch. Int. Med. In press. 2002

5. Countries ranked by the estimated number of TB cases attributable to HIV (thousands) - 2000 Above red line: 80% of total number; above black line: 90% of total number Rank Country Number Rank Country Number 1 S. Africa 77.8 16 Rwanda 7.6 2 Ethiopia 59.2 17 B. Faso 6.5 3 Nigeria 49.9 18 Burundi 6.4 4 Kenya 43.9 19 Ghana 6.0 5 India 41.4 20 Thailand 5.6 6 Zimbabwe 29.2 21 Botswana 5.5 7 Tanzania 25.2 22 CAR 4.9 8 DR Congo 22.6 23 Myanmar 4.9 9 Mozam. 21.5 24 Lesotho 4.8 10 Zambia 18.9 25 Haiti 3.7 11 Uganda 17.3 26 Angola 3.1 12 Malawi 16.1 27 Namibia 3.1 13 C. d'Ivoire 15.0 28 China 2.9 14 Cameroon 10.1 29 Togo 2.4 15 Cambodia 7.7 30 USA 2.3

6. Stop TB Partners’ Forum Coordinating Board Partnership Secretariat WHO Technical Advisory Group Global TB Drug Facility W O R K I N G G R O U P S New TB Diagnostics DOTS-Plus MDR-TB New TB Vaccines New TB Drugs DOTS expansion TB/HIV Cross-cutting issues: Advocacy & Communications/ Financing THE FORM of the Global TB/HIV WG Stop TB Governance Structure

7. Recommendations of WG - 2001 • Policy development • Finish WHO/UNAIDS Strategic Framework • WG partners to promote national TB/HIV activities • District-level phased implementation of joint TB & HIV/AIDS programme activities • Prepare operational guidelines • WG partners to enhance TB and HIV/AIDS collaboration at international level • Continued support for ProTEST • Identify other TB/HIV joint activities • GA and WHA resolutions • Mobilise resources

8. Recommendations 2001 • Develop 5 year workplan • WG partners to promote and support research • 2nd meeting of WG to review progress in implementation of recommendations and setting future direction

9. Strategic framework Analysis of interaction between TB and HIV/AIDS programmes in sub-Saharan Africa Report of the First WG meeting Distributed 4th World Congress Barcelona AIDS Conference Media UNAIDS and WHO lists Work in progress: Mathematical modelling of impact of interventions Review of the epidemic of TB and HIV and implications Review of the impact of HIV on recurrence and relapse of TB and recommendations for policy Policy Development

10. Phased implementation of district level joint TB & HIV/AIDS activities Nairobi workshop, February (AFRO,CDC-GAP,USAID) Country support, Ethiopia, Kenya, Zambia, Mozambique, Tanzania Mentors WHO staff Evaluation of ProTEST Behavioural Cost-effectiveness Operational guidelines for national and district use Development of standardised data collection instruments Review of proposals by Scientific Panel of WG, July Review and completion of operational guidelines by SP Partner support, eg CDC-GAP (Zambia) USAID (Ethiopia) WHO “Brokerage” of support, eg GFATM World Bank Promotion of National TB/HIV Activities

11. Expanding collaboration within WHO HQ TB focal points Joint staff Joint approach to country support, GFATM & WG GA and WHA resolutions Failed Continued support for ProTEST Identification of other TB/HIV joint activities Establishment of WG core group Work in progress Mobilise resources Database Assistance with GFATM proposals Enhancement of TB and HIV/AIDS collaboration at international level

12. And... • Promotion and support of research • Working paper in preparation on priorities • Development of a 5 year workplan • Planned • Organisation of 2nd Global TB/HIV WG meeting • Review of progress in implementation of recommendations • Future direction of activities

13. External environment • Key Happenings: • Commission for Macroeconomics and Health • GFATM • ?3 TB/HIV projects supported • World Bank, HIPC and PRSP • Shift in HIV community to “care” and hence openness to TB • Shift in TB community to address HIV as driving force of TB epidemic • Implications: • Financial resources need not be rate-limiting • Countries are in the driving seat • Demand for high quality technical support remains • Human resources are key bottleneck

14. Future Directions - Recommendations • Continued focus on country support • Close collaboration with HIV/AIDS community • Close collaboration with DOTS Expansion WG • Continue to build evidence for joint TB & HIV programme activities • Focus WG’s global efforts on 25 countries with 90% of the TB/HIV burden • Approach Nigeria and Zimbabwe • Continue with plan for francophone workshop • Consider India and other large countries • Work with RO’s on countries outside Africa • Continue to seek financial resources • Start to address human resource constraints

15. Ways of Working - Recommendations • Improve terms of reference of WG • Strengthen core group and focus on strategic direction of WG • Strengthen partnership • Increase human resources • Address financial resources

16. Work-plan of partners • Agreement on technical strategy • Agreement on geographic focus - for debate • Country level plans - begun, requires further planning • What, how, by whom, when? • Costing • Identification of sources of support - begun, requires further work • for WG activities • for technical support, co-ordination • for implementation • Financial gaps - to be defined

17. “There is a tide in the affairs of men, Which, if taken at the flood, leads on to fortune; …..On such a full sea are we now afloat; And we must take the current when it serves, or lose our ventures.” W. Shakespeare (Julius Caesar)

18. Acknowledgements • Dermot Maher, Philip Onyebujoh, Fabio Scano, Brian Williams • Elyse Kingery, Zahra Ali-Piazza, Nellie Courcoulas, Linda Clemensson • Charlie Gilks, Massimo Ghidinelli, Bernhard Schwartlander • Vainess Mfungwe, Wilfred Nkhoma, Eugene Nyarko • Leo Blanc, JW Lee, Mario Raviglione • Patrick Bertrand • Petra Heitkamp, Michael Luhan