By Shobha Shukla
TB continues to be the most common opportunistic infection as well as the biggest cause of deaths of people living with HIV despite decades of progress in diagnosis, treatment and prevention. TB is preventable and curable but it was not so for over 150,000 people living with HIV who died of TB in 2024, as per latest UNAIDS report 2026 launched at 26th International AIDS Conference 2026 (AIDS 2026).
“If we could have prevented TB better among people with HIV or found TB earlier in them and treated it with medicines that work against their TB bacteria, we could have saved these lives. No one needs to die of TB, or HIV” says Prevent-Find-Treat ALL TB campaign. There were over 570,000 deaths in 2025 due to AIDS-related illnesses.
The challenge is not simply the availability of medical tools – it is ensuring that people are identified early enough and connected to care before the disease progresses – with human dignity and respect to their human right to health.
Experiences shared by Humana People to People India (HPPI) experts at AIDS 2026 suggest that one of the most effective ways to bridge this gap may already exist within India’s health system: integrating latest science and evidence-based TB services into established HIV care and prevention platforms rather than creating entirely new programmes – and that too in person-centred manner and led by communities.
HPPI’s National Partnership Officer Jahangeer Alam (a TB survivor and TB champion himself) and National Technical Advisor for TB, HIV and Health Dr Sugata Mukhopadhyay, described how strengthening collaboration between Government of India’s National TB Elimination Programme (NTEP) and National AIDS Control Programme (NACP) is helping identify TB earlier, improve treatment completion and place people – not diseases – at the centre of healthcare.
A Hidden Challenge
According to Jahangeer Alam, TB remains the leading cause of death among people living with HIV, accounting for one in four HIV-related deaths globally.
The concern, he explained, is that TB among people living with HIV often does not follow the classic clinical picture.
Many individuals may not present with persistent cough, fever, weight loss or other commonly recognised symptoms. When healthcare systems depend solely on symptom-based screening, many infections remain undetected until the disease has already advanced.
Late diagnosis not only worsens health outcomes for the individual but also increases opportunities for continued transmission.
Another obstacle is that TB screening is not always fully integrated into routine HIV care and antiretroviral therapy (ART) services. Layered on top of this is the persistent intersectional stigma surrounding both HIV and TB, which is a formidable barrier for many people from seeking care early.
These realities make service integration more than a matter of efficiency – it becomes a clinical and human rights necessity.
Turning every HIV visit into an opportunity to stop TB
To address these challenges, HPPI worked alongside government-run ART centres (where persons living with HIV come for collecting their lifesaving antiretroviral medicines and accessing other services) in Delhi and the government’s National TB Elimination Programme to strengthen TB-HIV integration using an intentionally simple approach.
Rather than establishing new systems, the organisation used existing HIV care platforms to actively search for TB among people already attending ART centres. Since 7th December 2024, Government’s TB programme had already made a science- and evidence-based foundational shift on how it finds TB by deploying artificial intelligence (AI) enabled handheld ultraportable X-Ray TB screening and offering upfront molecular tests to those with presumptive TB. More importantly, these tools were taken in a van to high-risk communities across the country. Government-run programme found over a million asymptomatic people with TB disease in a year – none of them would have been found so early without this approach.
Between May and July 2026, HPPI screened 1,363 people living with HIV using a comprehensive ten-symptom verbal screening tool alongside chest X-ray assessment. Individuals identified as having presumptive TB subsequently underwent upfront rapid molecular testing.
The results highlighted the value of proactive screening.
Among the 1,363 people screened, 259 were identified as presumptive TB cases, all of whom received diagnostic testing. Twenty-one individuals were diagnosed with TB and promptly linked to treatment.
Perhaps the most significant finding, however, was that 12 of the 21 confirmed TB patients—57 percent—had no symptoms.
For Alam, this was a powerful reminder that the absence of symptoms does not necessarily mean the absence of disease.
Without systematic screening that combined symptom assessment with chest X-ray and rapid molecular diagnostics, more than half of these TB cases could potentially have remained undetected.
The experience reinforced an important lesson: every interaction between people living with HIV and healthcare providers represents an opportunity to identify TB before symptoms become severe.
The power of community platforms
While ART centres offer one important point of contact, Dr Sugata Mukhopadhyay described another equally significant opportunity – the extensive community-based HIV prevention network already operating across India.
India’s HIV prevention programme currently reaches approximately 15.8 million people through Targeted Intervention projects, Link Worker Scheme projects, Opioid Substitution Therapy centres and other outreach platforms.
Many of these populations – including female sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs, migrant workers and truckers—not only face elevated HIV risks but are also vulnerable to TB.
Instead of creating parallel TB programmes for these communities, HPPI strengthened the capacity of existing outreach workers.
Community staff received training to conduct TB symptom screening, educate communities about both TB and HIV, reduce stigma and establish referral pathways with the National TB Elimination Programme for diagnosis, treatment and preventive therapy.
The approach demonstrated that integration can be both practical and sustainable because it builds on trusted relationships that already exist within communities.
Rather than introducing unfamiliar health workers, the programme relied on outreach teams who already knew where vulnerable populations lived, worked and sought support.
Trust, both HPPI leaders suggested, became one of the programme’s strongest assets.
Beyond detection to continuum of care
HPPI’s experience extended well beyond finding TB cases. Dr Sugata Mukhopadhyay emphasised that the organisation adopted an approach that follows individuals across the entire continuum of care.
Instead of stopping at diagnosis, the HPPI model supports people through TB treatment initiation, adherence, treatment completion and, where appropriate, TB preventive treatment for eligible household contacts and people living with HIV. Community-based regular follow up and support is so critical to help so many underserved people to journey from diagnosis to treatment to cure.
Drawing on experiences from four HPPI projects – three Targeted Intervention projects in Delhi, Unnao (Uttar Pradesh) and Kathakota (Telangana), together with one Link Worker Scheme project in Lucknow—the organisation integrated TB activities into routine HIV outreach without creating a separate service-delivery structure.
The results over the five-year period from 2020 to 2025 demonstrated the potential of this approach.
Among HIV high-risk populations, more than 113,000 people were screened for TB symptoms. This led to 671 individuals being diagnosed with TB, initiated on treatment and successfully ALL completing treatment.
The programme also extended beyond those directly diagnosed with TB. A total of 433 eligible household contacts completed TB preventive treatment, reducing their future risk of developing active disease.
Among people living with HIV, more than 500 individuals were screened, 11 people were diagnosed with TB, and all were started on treatment. In addition, 301 eligible people living with HIV completed TB preventive treatment.
For Mukhopadhyay, however, the numbers tell only part of the story.
The greater achievement lay in demonstrating that comprehensive TB services can be delivered through existing HIV programmes without establishing parallel systems or requiring major additional financial resources.
No parallel systems, better outcomes
A recurring point stressed by both experts Alam and Mukhopadhyay, was that integration is not simply about combining two health programmes. Instead, it involves making better use of what already exists.
Rather than creating new infrastructure, HPPI strengthened the skills of existing frontline workers, expanded their responsibilities and deepened collaboration with government health programmes.
Community outreach workers became central to the model – not only screening individuals for TB symptoms but also providing regular follow-up and support (and filling the gap as far as possible which people may face), counselling families, reducing stigma, supporting referrals, following up on treatment, assisting with adherence and facilitating contact investigations.
Because these workers already have trusted relationships within communities, they are often able to reach people who may otherwise avoid health facilities because of discrimination, fear or social barriers.
By leveraging these existing relationships, integration became both practical and cost-effective.
As Mukhopadhyay noted, the model was about “doing things differently – not necessarily doing more things separately.”
Lessons from the field
Jahangeer Alam and Dr Sugata Mukhopadhyay call for 5 actions:
First, symptom-based screening alone is insufficient for people living with HIV. Additional diagnostic approaches – including chest X-rays and upfront rapid molecular testing – can identify TB even when individuals have no obvious symptoms. But most essential is that all services must be person-centred, community-based and community-led, rights-based and ensure equitable access.
Second, every interaction with HIV services should be viewed as an opportunity for TB screening. Waiting until symptoms become severe risks delayed diagnosis, catastrophic costs, more infection spread, and poorer outcomes.
Third, successful integration depends on strong coordination between government-run HIV services and the National TB Elimination Programme. Screening alone has little value unless people are rapidly tested, promptly started on treatment and supported throughout their care.
Fourth, community-based outreach remains one of the strongest assets available to both TB and HIV programmes. Trusted frontline workers can overcome stigma, improve awareness and maintain continuity of care far beyond the clinic walls.
Finally, both Alam and Mukhopadhyay stressed that integration is not just a public health imperative but also financially sensible. Existing health systems, trained staff and established community platforms already provide much of the infrastructure required. Better coordination – not necessarily greater expenditure – can produce significant gains.
Putting people before programmes
Healthcare systems often organise themselves around diseases. People, however, experience health very differently.
A person living with HIV does not separate TB, HIV, nutrition, mental health or other health concerns into distinct ‘siloes’ or ‘programmes.’ They experience them as a single life with interconnected challenges.
Both experts argued that health services should reflect this reality.
When TB and HIV services function independently, opportunities for early diagnosis, prevention and treatment may be lost. When services are integrated, people receive more comprehensive care, healthcare providers can respond earlier and programmes can work together rather than in isolation.
The emphasis, therefore, shifts from managing diseases to supporting people.
A model for the future
As India continues its efforts to eliminate TB and AIDS by 2030, HPPI’s experiences point towards a practical pathway that builds on existing strengths rather than creating new systems.
Proven impact of HPPI-run projects demonstrates that integrating community-based and supported TB screening, diagnosis, treatment and prevention into established HIV platforms is not only feasible but capable of identifying otherwise hidden cases, improving treatment completion and expanding preventive care among vulnerable populations.
Equally important, these initiatives show that collaboration between national programmes, community organisations and frontline workers can strengthen the continuum of care while making efficient use of available resources.
Ultimately, both Jahangeer Alam and Dr Sugata Mukhopadhyay delivered the same central message from different perspectives at AIDS 2026: people should never have to navigate fragmented health systems simply because diseases are managed separately.
When healthcare is organised around the needs of individuals rather than around programmes, opportunities for synergy are less likely to be missed, treatment begins earlier, preventive care reaches more people and health outcomes improve.
Integrating TB and HIV services is about more than efficiency. It is about ensuring that no person living with HIV remains undiagnosed, untreated or left behind – and recognising that one person deserves one coordinated system of care.
(The writer is a feminist, health and development justice advocate, and an award-winning founding Managing Editor and Executive Director of Citizen News Service)
