Goa to Munich: Growing call for 100-100-100 to end TB and end AIDS before 2030

Shobha Shukla / Bobby Ramakant *

Over 1500 people from 73 countries are unequivocally demanding that all people with HIV or TB must have access to full cascade of standard health services and social support in people-centred, rights-based and gender transformative ways. Unless best of WHO recommended prevention, diagnostics, treatment, care and support reaches everyone in need globally, we cannot end TB or AIDS.

Call for 100-100-100 to end TB and end AIDS by 2030 or earlier

This call for 100-100-100 was given at the AIDS 2024 (25th International AIDS Conference, Munich, Germany) Affiliated Independent Event organised on 4th of July 2024 in a special session where Goa Declaration was launched (read about Goa Declaration below). Goa Declaration calls for accelerated response to meet SDG target of #endTB, we must find all TB, treat all TB, and prevent all TB through people-centred and rights-based approaches.

Leave no one behind mantra

If we are to end AIDS, we must ensure that along with 100-100-100 (100% of people with HIV knows their status, 100% of people with HIV are on lifesaving antiretroviral therapy, and 100% of them are virally suppressed), we also have to ensure that no one suffers or dies of TB. According to WHO, “people living with HIV who have an undetectable viral load using any WHO-approved test and continue taking medication as prescribed have 'zero risk' of transmitting HIV to their sexual partner(s).” Undetectable equals untransmittable (#UequalsU) must become a reality for everyone with HIV.

We must ensure that 100% people with HIV know their TB status (on an ongoing basis), 100% of those with active TB disease are treated with medicines that work on them, and 100% of them are using a full range of appropriate combination prevention options to stop further spread of TB and HIV infections.

Also, 100% of those people with HIV who do not have active TB disease, must be offered TB preventive therapy (to reduce the risk of latent TB to convert into active disease).

Treatment is also prevention (in case of both TB and HIV) as it stops the spread of infection soon after initiation of treatment with effective medicines. Latest HIV and TB treatment regimens and prevention options must be accessible to all.

Additionally, we must advance stronger action towards #endHunger, #endTobacco, #endAlcohol, #preventDiabetes, #NCDs, and other risk factors associated with TB.

People-centred, rights-based and gender transformative approaches remain the bedrock to advance health programmes – including those for TB and HIV. Zero catastrophic cost, zero HIV and TB stigma (and self-stigma) and discrimination must be a reality for all.

This 14-hour hybrid AIDS 2024 Affiliated Independent Event was jointly co-hosted by 35 organisations worldwide and engaged over 1400 people from 73 countries. Co-hosts included: AVAC, UNAIDS Asia Pacific, International Community of Women Living with HIV (ICW), Global Network of People living with HIV (GNP Plus), Y+ Global, Y-PEER Asia Pacific, Society for AIDS in Africa (SAA – official secretariat of International Conference on AIDS and STIs in Africa - ICASA), APCOM, Zimbabwe National Network of People living with HIV (ZNNP+), Prevention Access Campaign, National Coalition of People living with HIV in India (NCPI Plus), AIDS Society of India (ASI), Ivorian Network of People living with HIV (RIP+ in Cote d'Ivoire), Cheyutha, Botswana Network on Ethics, Law and HIV/AIDS (BONELA), National Empowerment Network of People living with HIV/AIDS in Kenya (NEPHAK), MPLUS Foundation Thailand, KHANA (Khmer HIV/AIDS NGOs Alliance) Cambodia, Americas TB Coalition, TB People (Global), TB People (Nepal), TB People (Zimbabwe), TB People (India), TB People (Botswana), Humana People to People India, Rekat Peduli Foundation Indonesia, Pahal Foundation, People’s Health Organisation (PHO), Health TV Online Nepal, Asia Pacific Cities Alliance for Health and Development (APCAT), Asia Pacific Media Alliance for Health and Development (APCAT Media), Union South East Asia Trust (USEA Trust), Global AMR Media Alliance (GAMA), and CNS.

Goa Declaration

to meet SDG target of #endTB, we must find all TB, treat all TB, and prevent all TB through people-centred and rights-based approaches

Goa declaration has been endorsed by 107 people from the following 38 countries worldwide (as of 13 July 2024): Bangladesh, Benin, Burkina Faso, Cameroon, Democratic Republic of the Congo (DRC), Congo, Eritrea, Ethiopia, Ghana, India, Cote d’Ivoire, Jordan, Kenya, Kyrgyzstan, Malawi, Myanmar, Nepal, Nigeria, Peru, Philippines, South Africa, Sri Lanka, Tanzania, Chad, Togo, Uganda, Vietnam, Zambia, Zimbabwe, Costa Rica, Ecuador, Pakistan, Japan, Rwanda, Indonesia, USA, Lesotho, and Thailand.

Tariro Kutadza, who leads TB People (Zimbabwe), said in AIDS 2024 Affiliated Independent Event on TB and HIV that Goa Declaration was launched by the delegates who participated in the “United against TB: Accelerated action towards achieving SDG on tuberculosis” meet held in Goa, India (15th – 17th May 2024). Since then, many more people from around the world have endorsed the Declaration on an ongoing basis.

Goa Declaration recognises that ending TB by 2030 is a public health and human rights imperative, as well as critical to advance progress on other UN Sustainable Development Goals (SDGs) and targets.

Tariro puts on spotlight the promises made by world leaders as part of the UN SDGs (to be met by 2030) and Political Declaration of UN General Assembly High Level Meeting on TB in 2023 (to be met by 2027).

Dr Samantha Tinsay, Municipal Health Officer, Bantayan Municipality, Cebu, Philippines shared few of the recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Wider scale up of the pilots of introducing new tools project (iNTP) of Stop TB Partnership and USAID that have shown impact in terms of finding more TB cases and linking them to care in a time bound manner.

- Prioritising taking WHO recommended point-of-care TB screening and diagnostic tools to the people’s doorstep, over optimising existing centralised or semi-centralised or lab-dependent tools or models which often have access barriers, result in diagnostic delays, catastrophic costs, and drop out of people from the care cascade.

Catherine Murombedzi of TB People (Zimbabwe) and a noted health journalist shared the following recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Effectively engaging communities in the response to TB at every level. TB survivors, affected communities, and community health workers bridge a deadly divide between existing services and most-at-risk populations.

- Community-led monitoring is another evidence-backed method to engage communities in TB programmes meaningfully as well as improve the service uptake from people’s point-of-view. We must listen to the people and communities we serve. Community leadership is also pivotal for demand generation for equitable access to the full range of TB services.

- Phasing out upfront use of microscopy completely and replacing it with WHO recommended molecular tests.

- Increasing TB testing for children with samples that do not depend on sputum only (for example, stool or other methods).

- Effectively integrating TB programmes with other health and development programmes, such as those on HIV, NCDs, HCV, harm reduction, nutrition, tobacco control, among others.

Tarit Chakraborty from TB People (India) shared the following recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Screening everyone for TB regardless of symptoms in high burden settings. With an alarming number of TB prevalence surveys showing that a large number of people with TB are asymptomatic, it is imperative to find all people with TB early enough by deploying evidence-based tools like ultraportable x-rays for population-wide screening (regardless of symptoms) and confirming those with presumptive TB on molecular test upfront. - Linking all of them to care will help stop the infection-spread. Increasing use of mobile/ outreach clinics for population-based screening will help. Where appropriate, intensified TB screening of everyone (regardless of symptoms) should be done in private sector facilities too.

- Making same day 'test and treat' a reality for everyone with TB including Key and Vulnerable Populations.

- Optimally leveraging upon public private mix approaches to engage all healthcare providers in TB responses should be prioritised.

Dr Tin Maung Htwe, a senior journalist and editor from Myanmar shared the following recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Ensuring that universal and upfront drug susceptibility testing (DST) is a reality for every person diagnosed with TB. Doing universal DST will also increase diagnosis of drug-resistant forms of TB, prevent the spread of drug-resistant strains, reduce human suffering and untimely deaths. It will also reduce diagnostic delays and catastrophic costs. We appeal to the world leaders who will meet at the United Nations General Assembly High Level Meeting on Antimicrobial Resistance (AMR) to scale up response to drug-resistant TB.

- Following up with those who are cured of TB or who have completed the treatment with regular screening as per the guidelines.

- Tapping into extra budgetary resources to fill the funding gap so that the response to find all TB, treat all of them and prevent transmission is fully funded, along with TB R&D for new safe and effective tools.

Nurul Islam Hasib, President of Diplomatic Correspondents Association of Bangladesh and senior journalist with Dhaka Tribune shared the following recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- People-centric, rights-based and gender transformative pathways are a bedrock to rollout TB related screening and diagnostic tools, treatments, social and health support, and prevention services.

- Ending all forms of TB stigma and discrimination is vital as it is a major access barrier and violates human rights. TB stigma, intersectional stigma (stigma due to TB and a range of other issues, such as, HIV, gender diverse communities, work (such as sex work), prison inmates, among others), and self-stigma (internalised stigma) and all forms of discrimination must end.

- Engaging journalists and other media actors in TB responses as equal partners is important.

- Communication between media, TB scientists, researchers, survivors, advocates, programme managers at all levels, other stakeholders will help to keep them informed, involved, and supported. Media should help increase accountability and transparency in TB responses on the ground. Simplifying TB science and TB response in a language and manner which connects with masses is important.

Kalpana Acharya, Editor-in-Chief of Health TV Online Nepal and former President of Nepal Health Journalists Association shared the following recommendations of Goa Declaration in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Preventing all further transmission of TB. TB treatment is prevention as people with TB of the lungs who are on effective treatment, soon become non-infectious. It is also equally important to make the entire range of TB prevention methods accessible to people: such as, TB Preventive Therapy (TPT), tobacco cessation, quitting alcohol or other addictions, preventing and controlling NCDs, nutrition, infection control, among others.

- Making TB Preventive Therapy available for all eligible people (such as, contacts, people living with HIV, among others) in whom active TB disease is bacteriologically ruled out. Leveraging contact tracing through intensive screening among household and other close contacts of bacteriologically confirmed cases is vital. TPT must be made available along with full support including counselling to complete the therapy.

- Ensuring infection control practices in healthcare settings, communities, and homes are fully implemented.

Zarina Geloo, Editor of MESICA (Media Science Café) and senior journalist from Zambia shared the following recommendations of Goa Declaration, in AIDS 2024 Affiliated Independent Event on TB and HIV:

- Reducing delays in translating scientific achievements into public health gains. Roll-out of the existing latest TB screening and diagnostic technologies, latest treatment regimens, TB prevention methods, among others must reach everyone in need, everywhere – without delays. Eliminating delays in converting scientific breakthroughs (such as point-of-care molecular diagnostics, ultraportable x-rays, new treatment regimens) into public health gains is vital. It will also create a pathway for rollout of upcoming health technologies (such as new TB vaccines if found safe and effective).

- Supporting governments to roll-out latest treatment regimens, such as 1 month therapy for TPT, 4 months for drug-susceptible TB, and 6 months for drug-resistant TB.