HIV-related tuberculosis: how well are we doing with current control efforts?

SETTING: The top 25 human immunodeficiency virus (HIV) prevalence countries.
OBJECTIVE: To review the current status of implementation of interventions to control HIV-related tuberculosis (TB).
DESIGN: Using data on national TB and HIV programme activities from the most recent national survey results published by international public health agencies, we reviewed the status of implementation of selected key interventions to control HIV-related TB.
RESULTS: Regarding implementation of the DOTS strategy for TB control, only four of the top 25 HIV prevalence countries reported achieving the target for treatment outcomes. Nearly all countries reported low levels of national programme performance in implementing key HIV prevention and care measures.
CONCLUSIONS: The generally low performance of national TB and HIV programmes in the top 25 HIV prevalence countries is unlikely to make a significant impact on control of HIV-related TB. Controlling HIV-related tuberculosis requires increased investment in full implementation of the DOTS strategy and the key HIV prevention measures. In settings fully implementing these basic interventions, collaboration between TB and HIV programmes is necessary to scale up implementation of additional prioritised interventions to control HIV-related TB (e.g., antiretroviral therapy, intensified TB case finding and isoniazid and cotrimoxazole preventive therapies) that are of demonstrated feasibility, effectiveness and cost-effectiveness.