One-third of the world’s population is infected with Mycobacterium tuberculosis, the pathogen responsible for causing tuberculosis (TB). In 2007, there were 9.3 million incident cases of TB globally, 80% of which were in 22 countries. Despite the fact that diagnostic and treatment services for TB are integrated with primary health care in most countries, the number of deaths due to TB remains high—1.3 million in 2007.

Of the 15 countries with the highest incidence of TB, 14 are in Africa. This is largely due to HIV—40–50% of people with HIV will develop TB disease in their lifetime. In fact, 23% of the estimated two million HIV-related deaths in 2007 were due to TB.

What Jhpiego Is Doing

People living with HIV are 20 times more likely to develop TB in countries with a generalized HIV epidemic, and 26 to 37 times more likely where HIV prevalence is lower. Jhpiego is committed to integrating TB with all its HIV programs in order to improve the lives of women and their families through TB prevention, care and treatment. As a key implementing partner in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Jhpiego works with ministries of health, national TB & HIV programs, educational institutions and nongovernmental organizations to implement TB & HIV initiatives. In 2008, Jhpiego also joined the Stop TB Partnership, whose goal is to eliminate TB as a public health problem.

Highlights of Jhpiego’s experience implementing TB projects include:

Kenya

• Pregnancy increases the risk of developing TB, and TB in pregnancy may result in negative health outcomes for the mother and fetus. As prime partner for the USAID-funded AIDS, Population and Health Integrated Assistance Program (APHIA II) Eastern project, Jhpiego has incorporated TB screening and referral into the Focused Antenatal Care training package.
• Jhpiego supports advocacy, communication and social mobilization through training of providers and communities on TB prevention, diagnosis and control. For example, Jhpiego supports service delivery in prisons by training peers to support treatment, sensitizing prison officers and inmates, increasing laboratory capacity, providing clinical support and integrating TB & HIV services.

Mozambique

• With funding from CDC, Jhpiego is providing technical assistance to the Ministry of Health to develop a five-year national plan for TB infection control, including the preparation of a two-year priority plan of action.
• Jhpiego is also supporting the Ministry of Health in the development and implementation of a national TB infection control training package and will assist the Ministry of Health in training service providers.

South Africa

• In South Africa, Jhpiego is building the capacity of local partners to provide highquality, integrated workplace wellness programs, including HIV counseling and testing and TB screening.
• Jhpiego is providing technical assistance to nursing education institutions to ensure that new graduates are able to provide high-quality, integrated TB & HIV services.

Zambia

• Jhpiego has developed an on-the-job, competency-based training package for the diagnosis and management of opportunistic infections, including TB.
• To improve the quality of services, Jhpiego is working with the Zambian Defense Force to establish a standards-based management/performance improvement approach to TB & HIV prevention, care and treatment.

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