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November 2008
Vol. 18 No. 11
Global ID
WHO Promotes “Three I’s” for HIV/TB Co-infection

The World Health Organization (WHO) is calling for a worldwide focus on “Three I’s” for the prevention and treatment of tuberculosis (TB) in people living with HIV: isoniazid preventive treatment (IPT), intensified case finding (ICF) for active TB, and TB infection control (IC).

In recent years, as many lower-income countries have greatly expanded their HIV programs, they have found themselves confronting another, related threat: a dramatic rise in the number of persons infected with both HIV and TB. In 2008 alone, an estimated 230,000 people living with HIV will die as a result of TB, or some 630 persons every day.

WHO has created the Three I’s strategy in response. All three approaches have proved to be effective. Isoniazid prophylaxis can reduce the risk of TB for people living with HIV by between 33 and 62 percent. Intensifying efforts to find TB cases is important because while screening and diagnosing TB in people living with HIV can be difficult, once cases are found, TB can be cured. And infection control is key to preventing the spread of TB to vulnerable patients, health care workers, and the broader community.

“None of those things is very new and sexy, but what we think is new and sexy is actually that the three are being thought up together and as part of HIV care and treatment,” said Reuben M. Granich, MD, MPH, of WHO’s HIV/AIDS Department, at the 39th Union World Conference on Lung Health in Paris in October.

To scale-up the Three I’s worldwide in 2009, WHO plans to issue a screening algorithm and a single set of guidelines on intensified case finding and preventive treatment. WHO also separately plans to issue new guidelines for infection control in 2009.

Increased advocacy efforts involving other international institutions, policymakers, community organizations, and activists will be central to the WHO efforts, according to Dr. Granich.

Slides of Dr. Granich’s talk and others from the conference are available  online. (For Dr. Granich’s talk, see “Global Progress Report On Scale-Up Of The Three I’s.”)

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