Hidden Epidemic: Why TB Infection Control Is the Missing Link in the HIV Fight

TB infection control remains the weakest link in the HIV response, with experts urging integrated screening, preventive therapy and improved ventilation to reduce HIV-related TB deaths in Zimbabwe (image source)

Health experts warn that tuberculosis (TB) infection control remains the most overlooked yet decisive factor in combating HIV/AIDS — a gap that could determine whether Zimbabwe and other high-burden countries meet global mortality-reduction targets. Despite progress in HIV treatment access, TB continues to be the leading cause of death among people living with HIV.

The World Health Organization (WHO) and national health partners are urging governments to scale up infection prevention and control (IPC) measures for TB in both healthcare facilities and community spaces. These recommendations emphasise integrated screening, preventive therapy and improved ventilation to curb the airborne transmission of TB, especially in crowded clinics.

WHO’s consolidated guidance on HIV-associated TB promotes people-centred care models, which combine rapid molecular testing, TB preventive therapy (TPT) and community-driven engagement. “Adopting the full package of TB/HIV recommendations will save lives,” the guidance states.

In Zimbabwe, TB incidence among people living with HIV remains high, even as ART coverage continues to improve. The Ministry of Health and Child Care (MoHCC) says it is strengthening IPC systems through staff training, better facility ventilation and the establishment of TB infection control committees. “Every health worker should treat TB infection control as a safety culture, not a checklist,” said Dr. Agnes Mahomva, National AIDS Council coordinator.

Local organisations including The Union Zimbabwe Trust and Batanai HIV & TB Programme are supporting these efforts with mobile screening units and integrated TB testing within community ART outreach. They report that early detection and preventive therapy can reduce HIV-related TB deaths by up to 40%.

Experts highlight that practical interventions — triaging coughing patients, ensuring N95 mask availability, and improving airflow — are among the most cost-effective life-saving investments. But implementation barriers persist, particularly shortages of equipment, limited funding and stigma that discourages routine TB screening among people living with HIV.

“TB control is not just medical; it’s social,” said WHO TB specialist Dr. Tonderai Nyoni. “When we protect clinics from TB, we also protect the HIV response.”

Additional recommendations advocate for integrating TB and HIV services, expanding preventive therapy and upgrading clinic ventilation systems — steps considered essential to eliminating HIV-associated TB deaths by 2030.