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The World Health Organization (WHO) has
identified TB as one of the most important
emerging global health threats, with an
estimated one-third of the world population
infected with the causative agent. Despite the
existence of effective treatment, the disease
burden remains high due to logistic and
operational problems, including access to
treatment. Roughly 80% of all active
tuberculosis cases are found in Asia and
sub-Saharan Africa. Southern Africa has the
highest rate in Africa of people suffering from
both TB and HIV, accounting for more than 9
million of the 13 million people on the
continent. This underlines the need for greater
efforts to expand the control programmes.
The WHO states that at least 8 million people
acquire tuberculosis, while two million deaths
as a result of the disease are recorded every
year worldwide. Virtually wiped out in the
developed world, tuberculosis has for sometime
been regarded as a largely Third World disease.
Now nations, which not too long ago believed
themselves almost tuberculosis free, find that
the disease is back with a vengeance. This
year's theme for World Tuberculosis Day
on the
24th of March, “Every Breath Counts: Stop TB
Now” urged the public to identify people who
suffer from TB and encourage them to get early
treatment. WHO targets for global tuberculosis
control by 2005 include the successful treatment
of 85% of those detected and the detection of
70% of all cases.
Although HIV and tuberculosis often go
hand-in-hand,
AIDS has tended to overshadow TB
in recent years. The human immunodeficiency
virus (HIV), which causes AIDS,
is playing a big
role in the resurgence of TB since it lowers the
body's resistance, greatly increasing the chance
of contracting the disease. From the early
1990s, the annual number of new TB patients has
shown a steep upward trend with no sign of
slowing down. Under pressure of these increasing
numbers TB control has once again become
a major
challenge.
In its recent WHO Global TB Control Report 2004
WHO hails its treatment strategy for the disease
as a success. The Direct Observation of
Treatments (DOTS) scheme has been in place for
10 years and is used in 180 countries worldwide
to fight tuberculosis. The number of
tuberculosis patients diagnosed and treated
using DOTS*, the internationally recommended
strategy for TB control, is now rising much
faster than at any time since its introduction
in 1995, with the past two years witnessing
accelerated implementation of DOTS programmes
worldwide. The 2004 Global Tuberculosis Control
report confirms that DOTS programmes are now
treating three million TB patients every year,
an increase of more than one million patients
compared to just two years ago. That increase is
nearly double the average annual increment of
270 000 patients during the previous
six-year
period, and the rate is climbing.
India is leading the surge, accounting for more
than a quarter of all new DOTS cases being
treated, followed by smaller but significant
increases in five other key countries with high
TB rates: South Africa, Indonesia, Pakistan,
Bangladesh and the Philippines. "DOTS expansion
is one of the major public health success
stories of the past decade, one that is saving
thousands more lives every day," the WHO
Director-General conveyed. "But to
reach the 2005 targets for detection and
treatment, the challenge now is to add another
one million TB patients to DOTS programmes each
year.” Meeting the 2005 targets will put the
world's
TB control programmes on the path to
achieving the Millennium Development Goal (MDG)
of halving the global TB burden by 2015.
Expanding and strengthening DOTS is key to
halting the spread of TB because it is
cost-effective, ensures treatment compliance,
and prevents the development of drug-resistant
strains of TB. Of the 210 countries that
reported TB case notifications and/or treatment
outcomes to WHO in 2002, 180 are today
implementing the DOTS strategy and providing
access to services for nearly 70% of the world's
population.
The World Bank, a key member of the Stop TB
Partnership and a leading financier of
TB-related programmes in developing countries,
welcomed the WHO report as
evidence that donor
funding for expanding DOTS treatment had been
effective in improving the health and welfare of
communities afflicted by the disease. "This new
evidence is important. Speeding up TB case
detection is the critical first step in curing
more patients and driving down disease,"
the
President of the World Bank, James Wolfensohn,
commented.
"HIV/AIDS is driving the TB epidemic in southern
and eastern Africa and will worsen the situation
in eastern Europe, India and China in the years
ahead," the WHO Assistant Director-General for
HIV/AIDS, Tuberculosis and Malaria, pointed out. "We cannot control one without
controlling the other, and must begin rapidly
scaling up TB/HIV collaborative activities to
provide a synergy of prevention, treatment and
care for co-infected patients."
In Malawi, for
example, according to the National TB Control Programme, about 77% of all new TB infections
are a
result of HIV/AIDS. This underlines the
need to
implement joint AIDS and TB programmes
to tackle
both diseases simultaneously.
Despite the WHO's statement that the DOTS
programme is saving thousands of lives a day,
current treatments have come under fire. The
international humanitarian medical organization
Doctors Without Borders/Medecins Sans Frontieres
(MSF) says that methods developed in the
19th
century, and still in use today, must be updated
to control the growing TB epidemic. The frequent
coincidence of HIV/AIDS with TB makes it harder
to treat. MSF calls for an urgent increase in
worldwide investment in TB research and
development. "Delivering adequate TB care would
require a reliable diagnostic test for TB to
begin with, but we don't have one," the
President of MSF International
stated.
"A growing number of TB patients
worldwide also have HIV/AIDS, but the current
diagnostic tool can only detect
TB in 50% of
HIV-patients even in a well-run TB program."
A
diagnostic test for SARS was developed by the
Genome Institute of Singapore just months after
the outbreak of the disease in 2003. "TB kills
two million people every year, but where is the
sense of urgency that will secure resources and
accelerate the process of developing new tools
to fight it?" he asked.
According to a recent media release the United
States government will be spending roughly $200
million to develop new diagnostic and treatment
regimens, fund research for a TB vaccine,
monitor TB and multi-drug resistant TB around
the world, and support international TB
initiatives that ensure individuals with TB are
identified and successfully treated.
* The DOTS strategy comprises five main
elements:
1) political commitment,
2) diagnosis of TB patients through sputum
microscopy,
3) directly observed treatment of patients
taking their anti-TB drugs,
4) access to adequate supplies of quality drugs,
and
5) monitoring and accountability for every
patient diagnosed.
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