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  • Describe the global epidemiology of tuberculosis and HIV/AIDS
  • Understand how tuberculosis is transmitted, diagnosed, and treated
  • List the components of the DOTS strategy, the Stop TB Strategy, and the Global Plan to Stop TB
  • Discuss the current challenges to controlling tuberculosis in resource-limited settings and the recent advances in diagnosis, treatment, and prevention of tuberculosis
  • Describe the history, pathogenesis, diagnosis, and transmission of HIV/AIDS
  • Describe the treatment of HIV/AIDS including the prevention and management of opportunistic infections
  • Outline the policy and operational issues on treatment rollout, with particular reference to low- and middle-income countries
  • Discuss HIV/AIDS prevention strategies and their potential effectiveness and limitations at different stages of the epidemic
  • Know where to find additional resources for both tuberculosis and HIV/AIDS

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Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)—one a scourge nearly as old as humankind itself and the other a disease that emerged only 3 decades ago—are responsible for a significant burden of today’s global morbidity and mortality. When occurring separately, each is a challenge to cure or treat, but when occurring together they constitute a deadly pair. In many parts of the world, especially in many resource-limited settings, they are inextricably linked and have required a joint health sector programmatic response. Because of the large overlap that exists between both epidemics in the poorest parts of the globe, these diseases have been grouped in a single chapter. TB and HIV/AIDS are considered first separately and then together in this chapter.

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Global Epidemiology of Tuberculosis

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TB is ubiquitous. Approximately a third of the world’s population—more than 2 billion people—is infected with Mycobacterium tuberculosis (MTB). Under ordinary circumstances, about 10% of people infected with MTB develop active TB disease during their lifetime. The World Health Organization (WHO) estimates there were 8.8 million new cases of TB in 2010, with roughly 65% of these cases reported to public health programs and the WHO.1 In the same year there were an estimated 1.5 million deaths due to TB (roughly a quarter of which were HIV-associated), making it the leading cause of death from a curable infectious disease.1,2

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The vast majority of TB patients—over 80%—live in just 22 countries in the world. The list of 22 high-TB burden countries is dominated by the resource-limited countries of sub-Saharan Africa and Asia (Table 10-1) with India and China accounting for 40% of the notified cases in 2010. Strengthened TB control efforts and international investments have paid off. The absolute number of TB cases and TB incidence rates have been falling for at least the last 5 years (Figure 10-1).1 In the 2 decades between 1990 and 2010, significant decreases in global prevalence and mortality rates were observed. With approximately 75% of TB cases in resource-limited countries occurring among those in their most economically productive years (between the ages of 15 and 54), the human and economic toll on these countries ...

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