November 22, 2006

Dear Dr. Piot,

TB-HIV activists had first voiced their demand for greater coordination between UNAIDS and WHO TB programs to provide global leadership by increasing your inter-agency coordination in addressing TB-HIV in November 2005. We are pleased that there has been greater communication between UNAIDS and the WHO and the appointment of the TB-HIV Advisor at UNAIDS is a step that will be very helpful in facilitating greater attention to TB-HIV. However, there is still much that is to be done. On a country level, the WHO's Interim Policy on Collaborative TB/HIV Activities' are still not being implemented consistently in high TB prevalence areas. ARVs are offered to less than 5 % of PLWHA who are identified through TB programs. The further emergence of XDR TB, with its high mortality amongst PLWHA also highlights the immediate need for improved TB diagnostics, drug susceptibility testing and availability of first and second line treatment and points to the devastating impact that failure of TB programs and drug resistant TB can have, especially in PLWHA.

For all of these reasons, we wanted to write in light of the fact that World AIDS Day is around the corner to ensure that you will use that platform, as requested previously, to provide visibility to the issue of TB-HIV. It is important that AIDS leadership highlights the fact that TB, though curable, is a leading killer of people living with HIV and requires immediate programmatic coordination between TB and HIV service, program planning, and policy formulation. Though this collaboration is a must to provide urgently needed coordinated services to save lives of PLWHA, it is also clear that in the long run the fight against TB-HIV will only be won with new diagnostic, treatment, and vaccines that can accurately diagnose, treat, and prevent TB amongst PLWHA in a timely manner.

Besides the World AIDS Day, we also hope that you will be able to provide leadership to TB-HIV issues at the World TB Day related events in March of 2007.

We would also like to take this opportunity to thank you the increased communication that Dr. Mane and Nunn have been undertaking, and we are sure that this closer collaboration at the level of your global agencies will provide increased encouragement and pressure for improved TB-HIV collaborative activities on the country level. We look forward to the leadership that you can bring to the concerns of TB-HIV at the World AIDS and TB Day related events and to making the global leadership that you provide help stimulate similar levels of political visibility at country level.

Sincerely,