Evaluation of integration in WHO's tuberculosis, HIV, and antimicrobial resistance policies through the social-ecological lens

Background TB, HIV, and AMR are closely related global health challenges. In the context of limited global health funds and insufficient resources, an integrated tuberculosis, HIV and antimicrobial resistance prevention and control method will play an important role in the optimization of resources and cost-effectiveness. Objective This study aims to analyze the degree of policy integration for issues of tuberculosis, HIV and antimicrobial resistance in global health strategies and make recommendations for improving global health governance on related issues. Methods We conducted a thorough analysis of global health policy documents from January 2015 to February 2024, using both quantitative and qualitative approaches. Our focus was on assessing the integration effectiveness of current global health governance mechanisms in addressing tuberculosis, HIV, and antimicrobial resistance from the global governance view based on the content analysis through word frequency analysis and thematic framework analysis. Besides, we conduct a thematic framework analysis of the action plans and policy recommendations outlined in the most recent reports from UNAIDS, Stop TB, and UNEP on HIV, TB and AMR. Results The analysis revealed that most documents address TB, HIV, and AMR in isolation, with limited integration and intersectionality. TB and HIV are more frequently linked, while AMR is less associated with the other two. The proposed action lacks specific provisions for joint implementation or monitoring of the evaluation. Additionally, no documented comprehensive overview includes the overall framework of three health priorities. Conclusions The study found that the current global health governance mechanism is significantly inadequate in dealing with integration solutions among tuberculosis, HIV and antimicrobial resistance. So we propose establishing integrated governance and coordination mechanisms for the same population at both horizontal and vertical levels, including individual, interpersonal, community, institutional, and societal levels, and developing an integrated policy framework to facilitate better resolution to address the association between TB, HIV infection and antimicrobial resistance in a resource-limited context. Clinical trial number Not applicable.