Scale-up of TB and HIV programme collaborative activities in Zambia – a 10-year review N. Kapata 1,2,3,4 , P. Chanda-Kapata 1 , M. P. Grobusch 4,5 , J. O’Grady 3,6 , S. Schwank 3,6 , M. Bates 3,6 , S. Jansenn 4,5 , A. Mwinga 7 , F. Cobelens 8 , P. Mwaba 1,2,3 and A. Zumla 3,6 1 Ministry of Health, Lusaka, Zambia 2 National TB and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia 3 University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia 4 Center for Tropical Medicine and Travel Medicine, University of Amsterdam, The Netherlands 5 Institute of Tropical Medicine, University of Tu ¨ bingen, Germany 6 Department of Infection, Division of Infection and Immunity, University College London, UK 7 Centres for Disease Control and Prevention Zambia, Lusaka, Zambia 8 Department of Global Health, and Amsterdam Institute of Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands Abstract objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB) / HIV collaborative activities over the past decade. methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti-retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV-infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co-trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. conclusions The scale-up of TB / HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti-retroviral (ARV) rollout with improved treatment outcomes among TB patients co-infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB / HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV / AIDS (PLWHA). keywords TB, HIV, AIDS, anti-retroviral therapy, scale-up, Zambia, epidemiology Introduction The latest WHO (2011) states that in 2010, there were an estimated 8.8 million incident cases of tuberculosis (TB), 1.1 million deaths from TB among HIV-negative people and 0.35 million deaths from HIV-associated TB. The highest TB incidence rates occur in sub-Saharan Africa and are associated with high local human HIV infection rates. These countries are unlikely to reach the millennium development goal targets related to TB, mainly owing to the large numbers of HIV-associated TB deaths. Sub- Saharan Africa accounts for 78% of people with HIV- related TB globally (UNAIDS 2010a,b). In Zambia, TB and HIV / AIDS are important causes of morbidity and mortality and have become major public health issues (MoH, 2007; UNAIDS 2009a,b, Kapata et al. 2011). Zambia is the thirteenth country most affected by TB, with an incident rate of 433 per 100 000 population (WHO, 2011). Like many countries in sub-Saharan Africa, Zambia is in the midst of a serious TB epidemic which is likely due to the impact of HIV / AIDS (Chintu & Mwinga 1999; Mwaba et al. 2003). The HIV prevalence in the general population of nearly 13.4 million people is cur- rently estimated at 14.3% (UNAIDS 2010a,b). HIV prevalence rates increased since the late 1980s, peaked to up to 28% in the late 1990s and declined by more than Tropical Medicine and International Health doi:10.1111/j.1365-3156.2012.02981.x volume 00 no 00 ª 2012 Blackwell Publishing Ltd 1