World Health Organization rings the alarm on rising tuberculosis infections

The World Health Organization’s (WHO) latest global tuberculosis (TB) report reveals rising infection rates and calls for cross-sector action to address the key drivers of TB infections and deaths.

What is the report about?

The WHO’s Global Tuberculosis Report 2024 describes the status of the global TB epidemic. It measures the progress being made to end TB by 2030 against targets adopted by UN and WHO member states. The 2024 report is based on 2023 data submitted by 193 countries.

Why is this report important?

More than 10 million people fall ill with TB every year and this number is rising. 

If you work on HIV, being aware of what is happening in the TB epidemic is important. TB is one of the most common co-infections that people with HIV can get. People with HIV who are virally unsuppressed can’t fight TB in the same way that people with healthy immune systems can. This means that TB can make people with unsuppressed HIV very ill, especially if they do not get TB treatment or their TB is drug-resistant. 

What does the report say?

Around 8.2 million people were newly diagnosed with TB in 2023, compared to 7.5 million in 2022. This is the highest number of new infections since WHO began monitoring TB in 1995. This means TB was the most common deadly infectious disease in 2023, surpassing COVID-19. 

In 2023, 6.1% of all new TB infections were among people with HIV. This proportion was much higher in the WHO African Region, where it was over 50% in some parts of southern Africa.

In 2023, 10.8 million people fell ill with TB. This is a small increase from 10.7 million in 2022, although it is much higher than 10.1 million in 2020.

Despite rising infection and illness rates, progress is being made on reducing TB-related deaths. TB caused an estimated 1.25 million deaths in 2023, of whom 161,000 were among people with HIV. Around half (48%) of TB deaths among people with HIV were among men, 36% were among women, and 16% were among children and young adolescents. Data was not available for TB-deaths among trans and non-binary people. 

TB infections are driven by five major risk factors. Having HIV is one of these, alongside being undernourished, having alcohol use disorder, smoking (especially among men) and having diabetes.  

Progress is being made to reduce the risk of TB for people with HIV. Coverage of TB preventive treatment has been sustained for people with HIV at around 2 million people per year. It continues to improve for all household contacts of people diagnosed with TB, rising from 0.76 million in 2021 to 2.7 million in 2023.

The success rate for people on treatment if their TB is drug-susceptible remains level at 88%. But this rate is lower among people with HIV, at 79%. Multidrug-resistant TB continues to pose a significant threat, particularly to people with other conditions, such as HIV.

In 99 countries or areas, at least 90% of people diagnosed with TB knew their HIV status. This was true for 31 of the 47 countries in the WHO African Region, where the prevalence of HIV-associated TB is at its highest.

For the first time, the report reveals the economic burden households face if they need to access TB testing and treatment. It finds that around half of TB-affected households in low- and middle-income countries face ‘catastrophic costs’, defined as more than 20% of annual household income.

What does this mean for HIV services?

HIV is one of a number of connected issues that need to be considered and addressed to stop people, especially men, getting ill and dying from TB. Those working on TB, HIV, diabetes, nutrition, alcohol use disorder and smoking prevention need to work more collaboratively to provide the integrated services that people need to protect their health from the risk that TB poses. 

Rising TB infections and illness clearly show that TB has not gone away. There is an urgent need to ensure that all people with HIV can access and stay on ART so they are able to protect their immune system and fight TB if they get it. While people newly diagnosed with TB need access to HIV testing. People with HIV also need information and support to access TB preventative treatment, particularly those with unsuppressed viral loads, as well as TB testing and treatment if needed.

Findings on TB costs to households suggests that many people cannot afford to get the TB care they need. Integrating HIV and TB services can be one way to keep some of these costs down.