Maher BMC Public Health 2010, 10:394 http://www.biomedcentral.com/1471-2458/10/394 Table 4: Indicators of progress in implementation of collaborative TB/HIV interventions intervention screening for tuberculosis among people with HIV testing for HIV among notified tuberculosis cases provision of isoniazid preventive therapy to people living with HIV TB infection control in health and other congregate facilities number of people accessing intervention in 2007 300,000/13 million target in Africa (2.3%) [13] 500,000/900,000 target in Africa (55.6%) [13] 27,000/33 million people living with HIV worldwide (0.1%) [46] no quantitative measure ("progress in implementing infection control interventions has been very slow" [46]) tion, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens), drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens), research and develop- ment for new diagnostics, drugs and vaccines, global advocacy and global partnership. Implementation of these activities by the two programmes depends on the same health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, financing, and health sector reform. Identifying such activities where joint efforts for HIV and for tuberculosis epidemic control can strengthen health services would help to maximize synergies (Table 5) [4,11-13,27,44,46,49,51,52,57,58]. The global economic crisis highlights the urgent need for international and national health organizations to review systematically the activities of HIV and tuberculosis programmes to identify opportunities for greater synergies between these indi- vidual health programmes and the health system and to deliver better results and value for money. There are recent signs of an increasingly favourable global policy environment for this approach. Last year WHO launched the effort to "Maximize positive syner- gies between global health initiatives and health systems" [59]. Dr Carissa Etienne, assistant Director-General, WHO, has commented that "The financial crisis poses some fundamental questions about the way the interna- tional community uses its resources. And the response is that while we clearly need more funds for health, we also need to identify opportunities to deliver better results Page 7 of 11 and value for money...promoting greater synergies between health systems and individual health pro- grammes are key to making this happen" [60]. Suggested reforms in international health financing include incor- porating the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance on Vaccines and Immunisations in a global fund for all the health Millen- nium Development Goals, with a mandate to address pri- ority health problems and key bottlenecks in health systems [61]. Conclusion The global financial crisis threatens global health [62], in particular exacerbating diseases of inequality such as HIV/AIDS [63] and diseases of poverty such as tubercu- losis [64]. The benefits of collaboration between those concerned with HIV and tuberculosis epidemic control have been pointed out for a long time [65]. However, despite some recent progress, collaboration remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve the goal of universal access to key interventions. "Crisis" is a medical metaphor derived from the concept which probably predates Hippocrates of the turning point of a disease - the moment after which a patient either recovered or died. As both a danger and an opportunity, the global financial crisis may entail disaster or recovery for global health sector efforts for HIV and tuberculosis epidemic control. International health agencies should review policies and progress in epidemic control of HIV and tuberculosis, with the aim of identifying synergies: learning mutual lessons for policy development and for scaling up implementation of interventions and identify- ing ways of joint planning and joint funding of integrated services as part of strengthened health systems. Although the global financial crisis poses a danger of increased funding gaps for HIV and tuberculosis epi- demic control programmes, it also represents an oppor- tunity to re-think established practices and policies, with the aim of delivering better results through greater health system synergies with increased cost-effectiveness. The silver lining in the global economic crisis could be better control of the HIV and tuberculosis epidemics, better overall health system performance and outcomes, and better value for money. Summary • The global financial crisis represents both a danger and an opportunity for global health sector efforts for HIV and tuberculosis epidemic control. • HIV and tuberculosis share many similarities in terms of their disease burden and the stratagems for epidemic control.