In most areas of the world, the battle against tuberculosis is being successfully fought, but in Africa the disease has reached alarming proportions with a growing number of TB cases and deaths linked to HIV, the World Health Organization (WHO) said in a new report released today.
The Global Tuberculosis Control report for 2005 finds that global TB prevalence has declined by more than 20% since 1990 and that incidence rates are now falling or stable in five of the six regions of the world. The glaring exception is Africa, where TB incidence rates have tripled since 1990 in countries with high HIV prevalence and are still rising across the continent at a rate of 3-4% annually.
Even Uganda, an African HIV reduction success story, is today curing fewer TB patients than it did four years ago. More than half of all people with TB in Uganda remain without access to life-saving DOTS (*) services due to strained general health facilities.
"Evidence in this report provides real optimism that TB is beatable, but it is also a clear warning," said WHO Director-General Dr LEE Jong-wook. "As Nelson Mandela has said, we can't fight AIDS unless we do much more to fight TB, and it is time to match his words with urgent action in Africa on the two epidemics together."
There has been major progress in China and India, which account for one third of the global TB burden. Both are leading the accelerated response to TB control by rapidly scaling up DOTS. As a result, the number of cases treated under DOTS worldwide rose 8% in 2003 compared to the previous year. Other countries such as Indonesia and the Philippines are showing similar progress.
Assuming strong commitment and resources are sustained, four regions - the Americas, Eastern Mediterranean, South East Asia and Western Pacific - are on track to reach the United Nations Millennium Development Goal of reducing TB incidence by 2015. The two exceptions are Africa due to the TB/HIV co-epidemic, and Europe where there are high levels of multidrug-resistant TB and slow advances in DOTS in countries of the former Soviet Union.
"Dedicated frontline health workers are making a difference, reaching out to the most vulnerable," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "But we need to push even further, to work with new partners in both public and private health sectors, and in all regions, to reach more than half of all patients that are still without access to DOTS treatments."
Since 1995, over 17 million people with TB have benefited from effective treatment under DOTS. But more could be achieved within countries, and in research into new diagnostics, drugs and vaccines, if the annual US$ 1 billion funding gap for TB control was filled.
The urgency of addressing TB has been highlighted in the UK-led Commission for Africa, which linked improved TB control to strengthened health systems, as well as calling for full funding of WHO's 'Two Diseases, One Patient' strategy for improved TB and HIV intervention.
"It is a remarkable achievement that we are on target to reach the goal of halving TB cases by 2015 in most places," said the UK's International Development Secretary, Hilary Benn. "The Department for International Development is a strong supporter of TB programmes in some of the countries which have been making the fastest progress. However, as both the Global TB Control report and the Commission for Africa report stress, the destructive link between TB and AIDS in Africa is causing an increase in cases. I call on the international community to step up efforts to tackle both of these diseases together."
(*)DOTS is the internationally recommended strategy for controlling TB, consisting of five elements:
- Government commitment to TB control
- Diagnosis through bacteriology and an effective lab network
- Standardized short-course chemotherapy with full patient support throughout treatment
- Uninterrupted supply of quality-assured drugs
- Recording and reporting to measure patient and programme outcomes
World TB Day on March 24th is a Stop TB Partnership initiative aimed at raising TB awareness internationally. WHO is one of 325 members of the Stop TB Partnership committed to controlling and ultimately eliminating TB as a public health problem. Since the Partnership's formation in 2001 the number of patients detected for TB has increased by two thirds.
Report: Global Tuberculosis Control 2005: Full text