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Challenges in TB/HIV management in a country with a concentrated HIV epidemic.

The global push to reduce tuberculosis (TB)-associated deaths in people with HIV has focused on settings where both diseases are characterized by epidemics among the general population. Although these settings may indeed offer the greatest potential for reduction of TB/HIVassociated mortality, it is also necessary to consider how to reduce mortality in settings with different TB/HIV epidemiologic profiles. For example, many countries in Asia, Europe, and Latin America have generalized TB epidemics but HIV epidemics concentrated in key populations. Peru is one such country; it has the second highest TB burden in the Americas [1], but while only 0.3% of adults 15–49 years in the general population are estimated to be infected with HIV [2], the prevalence of HIV is as high as 10–22% in MSM [3] and 30% in transgender women [4] (Table 1). For settings such as these, unique challenges arise for health systems and providers to manage both conditions simultaneously.