Tuberculosis (TB) remains a primary driver of infectious disease mortality in the Americas, with approximately 30,000 deaths reported in 2024. According to the Pan American Health Organization (PAHO), nearly 30% of these fatalities involve individuals co-infected with HIV. Despite advancements in antiretroviral therapy, late diagnosis continues to hinder mortality reduction efforts, leaving an estimated 77,000 people with undiagnosed TB across the region.
Why is TB/HIV co-infection a persistent health crisis?
The intersection of TB and HIV creates a unique clinical challenge where traditional diagnostic methods often fail. PAHO reports that many patients living with HIV present with atypical symptoms, such as extrapulmonary disease or paucibacillary manifestations, which are difficult to detect using conventional screening. This diagnostic gap means that nearly 77,000 cases went undetected in 2024, fueling ongoing transmission. According to PAHO’s HIV Treatment Advisor Omar Sued, the vulnerability of these populations requires a shift toward integrated, people-centered care models rather than siloed service delivery.
Nearly 1 in 3 deaths from tuberculosis in the Americas is linked to HIV co-infection. This highlights the critical need for screening protocols that address both conditions simultaneously.
What new technologies are improving detection rates?
Health ministries in the Americas are increasingly adopting rapid molecular tests and digital radiology assisted by artificial intelligence to close the detection gap. According to Ernesto Montoro, a Laboratory Integration Advisor at PAHO, the use of lateral immunochromatography (ICL-LAM) tests to detect urine lipoarabinomannan antigen has become a priority for identifying TB in people with advanced HIV. These tools allow for faster clinical decision-making, helping to bypass the limitations of traditional sputum-based testing that often proves ineffective for patients with low bacterial loads.
How are countries addressing implementation barriers?
Success in reducing mortality depends on bridging the gap between policy and clinical practice. Countries like Colombia and Ecuador are currently leading efforts to integrate these advanced diagnostic tools into their national health subsystems. Colombia has focused on reducing late diagnosis by refining its advanced disease screening protocols, while Ecuador is working to homogenize the use of LAM testing across diverse health networks. PAHO experts emphasize that the primary challenge is no longer just the lack of technology, but the programmatic integration of these tools into daily health service operations.
For healthcare providers, prioritizing the ICL-LAM test for symptomatic HIV patients can significantly reduce the time to treatment initiation, especially in cases where extrapulmonary TB is suspected.
Future trends in regional TB management
The regional strategy for the coming years centers on technical exchange and standardized diagnostic algorithms. PAHO is facilitating a series of virtual webinars, including a session on June 24, 2026, to align national TB and HIV programs with updated World Health Organization (WHO) recommendations. By sharing regional success stories and addressing common implementation barriers, the goal is to create a unified response that ensures equitable access to life-saving prevention and treatment schemes across the Americas.
Frequently Asked Questions
- Why is TB harder to diagnose in patients with HIV?
Patients with HIV often exhibit atypical or extrapulmonary forms of TB, which conventional diagnostic methods may miss. - What is the role of ICL-LAM testing?
The ICL-LAM test detects a specific antigen in the urine, offering a faster and more reliable diagnostic option for people with low bacterial loads or advanced HIV. - How many people remain undiagnosed for TB in the Americas?
According to 2024 estimates, approximately 77,000 individuals living with TB remain undiagnosed in the region.
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