Originally posted to the Elizabeth Glaser Pediatric AIDS Foundation blog. 

Too many people around the world have forgotten about the dangers of tuberculosis – particularly for mothers and children.

TB is a highly contagious bacterial infection that can be spread in saliva, most often through coughing, sneezing, or exhaling in close quarters.

While TB has a lower profile today, an estimated one-third of the world’s population is infected – and in sub-Saharan Africa, that infection is often paired with HIV.

As we mark the 30th World TB Day on March 24th, we remember that tuberculosis remains a danger for millions, and an important issue affecting maternal and child health.

While it’s the second-leading cause of death from an infectious disease worldwide, it’s the third-leading cause of death for women overall. And the World Health Organization (WHO) estimates that at least half a million infants and children become infected with TB every year, and 70,000 die from it.

Through my work at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), I’ve witnessed how mothers and children living with HIV are among the most susceptible to TB, particularly in sub-Saharan Africa.

HIV-positive pregnant women are ten times more likely to contract TB, and those with TB have a greater likelihood of passing HIV on to their infants through mother-to-child transmission. TB infection also leads to a much higher mortality rate for both mothers and babies.

For children, TB is a largely overlooked and neglected issue. Early detection and diagnosis of TB in children remains a challenge, particularly for HIV-positive children, who often have other HIV-related lung conditions and symptoms that mimic those of TB.

Children living with HIV have a higher risk of dying of TB because their immune systems are weaker, and treatment options are more limited. Medicines to treat TB in children lag behind the treatment options available to adults, and are often difficult to administer to young children.

The good news is that TB is preventable and treatable, and treating HIV and TB together can be highly successful. The WHO’s TB treatment guidelines point to combining TB treatments and antiretroviral therapy (ART) as an effective way to limit TB incidence by up to 90% in individuals.

This week, the WHO and the Stop TB Partnership highlighted the issue of pediatric TB, and how to reach zero TB deaths in children.

Working with USAID, the Elizabeth Glaser Pediatric AIDS Foundation is committed to reducing the risk of TB among children and HIV-positive mothers by improving integration of TB services within existing programs to prevent mother-to-child transmission (PMTCT) of HIV, and within broader maternal and child health (MCH) services.

In Uganda, where 54% of TB cases occur in people living with HIV, the Foundation supports rural health facilities that provide both TB treatment and HIV care through the STAR-SW project. In collaboration with USAID and the Uganda National AIDS Control Program, this program prioritizes active case finding for TB beginning with specific populations, such as HIV-positive pregnant women attending antenatal clinics (ANC).

Increasing screenings of HIV-positive pregnant women for TB and expanding TB testing to child immunization programs could help address HIV and TB co-infection in mothers and children in Uganda and throughout sub-Saharan Africa.

It is also important to trace contact and potential TB exposure among households to ensure that the whole family is diagnosed and treated.

Because maternal TB is associated with increased mother-to-child transmission of HIV, preventing TB among HIV-infected mothers and children must be a top priority for HIV programs in areas with high TB/HIV burden.

In our mission to create a healthy and thriving HIV-free generation, we must ensure that we do everything in our power to also keep that generation TB-free.

Dr. Serge Agbo is a Technical Officer on TB/HIV integration for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), based in Côte d’Ivoire.