WHO/Europe and MSF join forces to improve TB and HIV care across Eastern Europe and Central Asia

The Eastern Europe and Central Asia (EECA) region continues to face a dual burden of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) alongside concentrated HIV epidemics among vulnerable populations. In the region, AIDS-related deaths continue to rise and annual new HIV infections are not declining, leaving the region off-track to end AIDS as a public health threat by 2030. These infections confound each other, as TB remains the leading cause of death among those living with HIV.

The WHO European Region has made substantial progress against TB, with incidence declining by 39% between 2015 and 2024. This is the fastest decline of any WHO region, and more than 3 times the global fall in numbers of 12%; however, major gaps remain. In 2024, an estimated 204 000 people developed TB in the Region, while around 161 600 cases were detected, meaning roughly 1 in 5 people who developed TB remained undetected.

Drug-resistant TB (DR-TB) remains a major public health and health security threat, particularly in the EECA region. In the WHO European Region, an estimated 23% of new TB cases and 51% of previously treated cases have multidrug- or rifampicin-resistant TB (MDR/RR-TB), by far the highest proportions among WHO regions. An estimated 55 000 people developed MDR/RR-TB in 2024, while only around 27 000 cases were notified.

TB/HIV also remains a major concern, with around 29 000 new TB/HIV coinfections in 2024 and HIV present among approximately 13% of incident TB cases. The high burden of DR-TB also makes cross-border continuity of care a regional health security priority.

TB does not stop at national borders. When people move between countries, interruptions in diagnosis and treatment can lead to poorer health outcomes, continued transmission and the emergence and spread of further drug resistance. Stronger cross-border mechanisms for referral, information exchange and uninterrupted treatment are therefore essential for both people-centred care and regional health security.

Progress against HIV has also been uneven. Access to testing, treatment and prevention has expanded across the WHO European Region, with more than 344 000 people using pre-exposure prophylaxis (PrEP) in 2023 and the initial rollout of long-acting prevention options underway. Yet HIV incidence has plateaued, mortality continues to rise and 54% of new HIV diagnoses are made late. These challenges are especially acute in the EECA region, where late diagnosis remains common and access to PrEP is often insufficient to achieve prevention targets.

TB and HIV are closely connected. Around 29 000 people in the WHO European Region developed TB/HIV coinfection in 2024, and HIV was present among approximately 13% of people who developed TB. These overlapping challenges require earlier diagnosis, better-integrated services and uninterrupted care, including when people move between countries.

Against this backdrop, Médecins Sans Frontières (MSF), in collaboration with WHO and the Ministry of Health of Uzbekistan, is bringing together decision-makers and technical experts in Tashkent on 29-30 September to address the intersection of TB and HIV in the EECA region.

Around 90 participants - including heads of national TB and HIV programmes from 11 EECA countries, WHO representatives, international experts and other stakeholders - are gathering in Tashkent to discuss practical solutions to improve integration of TB and HIV services, accelerate uptake of new WHO-recommended tools and approaches, and strengthen regional coordination.

"Drug-resistant TB is a health security threat, and it doesn't stop at our borders," said Dr Ihor Perehinets, Regional Emergency and Health Security Director, WHO/Europe. "Someone who starts TB treatment in Tashkent needs to be able to finish it in Almaty or Warsaw. That's why countries need stronger cross-border mechanisms for uninterrupted care. We have better tools than ever to prevent, diagnose and treat TB and HIV, but only 2 in 5 people with drug-resistant TB are getting the treatments they need. That gap is what we are here to close."

Rapid implementation of the latest WHO-recommended, high-impact interventions, including optimized testing approaches, comprehensive advanced HIV disease services, and long-acting PrEP, could fundamentally alter the trajectory of the epidemic. These interventions are expected to reduce late HIV diagnosis and AIDS-related mortality while significantly decreasing HIV transmission and new infections among key and vulnerable populations.

"In a region where HIV infections are not subsiding and deaths continue to rise, scaling up proven interventions such as earlier testing, better HIV care and long-acting PrEP is critical to saving lives and preventing new infections," said Dr Stela Bivol, regional HIV adviser at WHO/Europe.

Discussions will focus on key priorities, including implementation of the latest WHO recommendations on PrEP, people-centred approaches to HIV and TB care, expansion of safer and shorter MDR-TB treatment regimens, and uninterrupted cross-border TB treatment for people who migrate.

"In 2025, the global HIV response reached an important milestone when WHO recommended lenacapavir as a groundbreaking long-acting injectable option for HIV prevention. This marked a major advance in efforts to prevent HIV and has the potential to reshape the response in this region, including in Uzbekistan," said Vickie Hawkins, MSF General Director. "Given the strong evidence supporting its safety and effectiveness, MSF calls on the Ministry of Health to consider adopting and introducing it in Uzbekistan. MSF stands ready to support the Ministry in this initiative, which aims to curb the spread of HIV in the country."

By bringing together key stakeholders, MSF, WHO and the Ministry of Health of Uzbekistan aim to create a platform to identify barriers to adoption, share practical lessons and operational experience, and explore how countries can accelerate uptake of new WHO-recommended TB and HIV tools. The workshop also supports efforts to update national programmes in line with the latest WHO recommendations.

"MSF has longstanding experience responding to TB and HIV in some of the world's most challenging settings, including across the EECA region," said Bern Nyang'wa, MSF Medical Director. "Given the high risk and frequency of TB/HIV coinfection, there is a clear need to strengthen cooperation and coordination between national TB and HIV programmes. Patients should not have to navigate fragmented systems to receive care for these closely linked conditions."

Through this workshop, MSF seeks to reinforce its commitment to supporting governments, communities and partners to expand access to quality, people-centred care across the EECA region.