Global Tuberculosis Control 2011

Published by: 
World Health Organization

This is the sixteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by 198 countries that account for over 99% of the world’s TB cases.

KAREN HOFMAN and STEPHEN TOLLMAN : Diseases that are just as serious as HIV/AIDS

UN meeting has finally alerted the world to what SA’s medical professionals have long suspected — the burden of cancer, heart disease, diabetes and chronic lung disease is as serious a threat as HIV/AIDS and tuberculosis to social and economic development.

THIS week’s first meeting of the United Nations General Assembly on noncommunicable diseases has finally alerted the world to what SA’s medical professionals have long suspected — the burden of cancer, heart disease, diabetes and chronic lung disease is as serious a threat as HIV/AIDS and tuberculosis to social and economic development.

AIDS breakthrough threatened by budget woes

After 30 years and over 20 million deaths in Africa alone, US researchers now report that early treatment of people infected with the human immunodeficiency virus (HIV) that leads to AIDS cuts transmission of the disease by over 96 per cent. The news has sent shock waves through the medical and scientific world. Unexpectedly announced by the US National Institutes of Health on 12 May after a six-year clinical trial, the discovery that anti-retroviral drugs (ARVs) can make people living with HIV far less infectious means that humanity finally has the tools to reverse the global epidemic.

Early ARV treatment will save lives

Government's decision to offer free ARV treatment to people with CD4 counts of 350 or less has been welcomed as a life-saver.


The South African government’s announcement that it will give antiretroviral medication to people with HIV who have CD4 counts of below 350 will save lives and prevent infection.

This is according to Medecins Sans Frontieres (MSF), which welcomed the announcement made by Deputy President Kgalema Motlanthe on Friday (12 August).

Until Friday, people were only able to get ARVs if their CD4 count was below 200 unless they were pregnant or had tuberculosis.

Experts examine NHI draft

Though it is expected to cost R214 billion by 2014 – more than double the current health expenditure – details of what exactly will be on offer under proposed benefits of the national health insurance (NHI) remain vague, while contributions will be mandatory for most working South Africans.

The NHI Green Paper, released on Friday, makes it clear cosmetic surgery, like botox and liposuction, and expensive spectacle frames would be excluded, as would treatment of anyone who did not go through the referral system.

But details yet to be fleshed out include:

* The income threshold above which contributions will be mandatory;

Big indaba for leading South African researchers and health experts

The National Health Research Committee (NHRC) will this week hold an important summit to look at the various health challenges facing the government. The summit takes place on Tuesday 26 and Wednesday 27 July 2011 at the Birchwood Hotel and OR Tambo Conference Centre, Boksburg, Ekurhuleni.

According to the chairperson of the NHRC, Professor Bongani Mayosi, South Africa is facing four main health challenges:

What's next for HIV prevention? Paying people to be healthy

Researchers are investigating the impact of offering financial incentives to people who are at risk of acquiring or passing on HIV, the International AIDS Society conference in Rome heard last week.

A large study in the United States is looking at whether a test-and-treat approach should be supported by offering incentives to newly diagnosed people who attend medical services and maintain an undetectable viral load.

Bad news for drug prices in middle-income countries

ROME, 20 July 2011 (PlusNews) - Middle-income countries with large numbers of people living with HIV will no longer benefit from preferential pricing when buying antiretroviral drugs from large pharmaceutical companies, according to the annual Médecins Sans Frontières drug pricing report, Untangling the Web of ARV Price Reductions.

Primary health care given a boost

Gauteng health has increased the budget allocation for district health services by more than a billion rand, says MEC Ntombi Mekgwe.

Tabling her budget speech, she said R7,014 billion has been allocated to district health services which was an increase of 18 percent from the previous financial year's allocation.

The department has a total budget of R25,2 billion for the 2011/12 financial year.

Mekgwe also announced that 112 community services doctors have been placed in clinics and district hospitals this year to strengthen primary health care.

Teams of specialists who will focus on maternal and child mortality will be deployed to districts.

"In this regard, we are in the process of finalising appointments of principal obstetricians, principal paediatricians, advanced midwives and senior primary care nurses."

She said principal family physicians have been appointed and deployed to each district.

"These specialists will be supported by fellow specialists from universities, tertiary and regional hospitals," she said.

Of the 35 community health centres in Gauteng, 30 would operate for 24 hours in order to improve access to primary health care services.

"The measures announced will enable clinics to deal with an increasing demand for services. The number of visits to clinics has increased from 19 million in 2009/10 to 20 million in 2010/11."

The department has also prioritised the prevention of HIV/AIDS and Tuberculosis, the reduction of substance abuse, the availability of drugs, early childhood development, as well as preventing violence against women and children.

An amount of R1.9 billion had been allocated to the HIV/AIDS programme to enable the department to increase the number of people on anti-retroviral treatment to 520,000 by March 2012.

HIV/AIDS: Debunking the spending backlash

JOHANNESBURG, 7 July 2011 (PlusNews) - National AIDS programmes are feeling the pinch as the international community and governments rethink their prioritization of AIDS over other infectious diseases. The withdrawal of support for the fight against HIV is gaining momentum and it is time to get angry, according to Francois Venter, head of the Southern Africa HIV Clinicians Society. He spoke to IRIN/PlusNews about debunking the five major claims fuelling the backlash against global HIV expenditure, drawing on work by University of Cape Town professor Nicoli Nattrass and long-time HIV activist Gregg Gonsalves.

Claim 1: AIDS spending is disproportionate to the disease burden

“People say AIDS shouldn’t be the priority. There are a whole lot of disaffected people who feel they lost out, so they might think it should go to… education, arms or whatever priority they feel is more important. We need to be harsh about this [claim] and say that we’re spending what we should be spending.

“We’ve actually spent so long underfunding health as a whole, and particularly HIV and tuberculosis, that we probably could be spending even more money now [on them].” 

Claim 2: The rise in HIV/AIDS spending has been at the cost of health spending elsewhere

Nattrass and Gonsalves have noted that while the proportion of HIV spending in health budgets globally more than doubled between the early 1990s and 2005, health spending increased generally – a gain Venter said was largely due to the advocacy around HIV.

“We have increased the amount of money being spent on health largely due to the advocacy around AIDS by saying, ‘this is the right thing to do’,” he told IRIN/PlusNews at the recent South Africa AIDS conference.

“If you look at the ‘pie’ it’s much, much bigger than it was 10 years ago. It’s still not big enough but we need to acknowledge that [progress on HIV] is not at the expense of a whole range of other things.”

Claim 3: The AIDS response undermined health systems by creating the “biggest vertical programme in history”

“I think we need to honestly acknowledge the fact that other health programmes are not functioning. I acknowledge the fact that the AIDS programme has been vertical and needs to be [integrated]. I think that AIDS programmes have had minimal impact on other programmes. The challenge for us in the HIV world is going to be to repair the rest of the healthcare system; we’ve made some real strides forward in terms of improving it.”

About 70 percent of HIV patients on treatment in the developing world receive drugs funding at least in part by the Global Fund to Fight HIV, TB and Malaria but Nattrass and Gonsalves highlight that more than one-third of the Fund’s money has gone to strengthening health systems.

The authors note that while the AIDS response initially centred around treatment activism focused on antiretrovirals and the prevention of mother-to-child transmission, it increasingly moved to other illnesses including tuberculosis, sexually transmitted infections and cervical cancer. 

Claim 4: The AIDS response has undermined health systems directly by attracting human resources out of the public health sector

While Nattrass and Gonsalves acknowledge this happened in some cases, they cite a review of studies that concludes that in most cases, the HIV response helped build better public health systems.

Claim 5: Prioritize HIV prevention and radically cut back on AIDS treatment

“This is the one that makes me the sickest and I cannot understand that in this day and age people have started arguing that we should take away drugs from sick people and turn them to [HIV] prevention,” Venter said.

“I don’t think anyone... would argue prevention is properly funded, or has enjoyed the support that everything else gets but to try and pretend that [prioritizing prevention over treatment] is something we can do without losing a lot of sleep over? It’s just rotten.”

Venter quoted Gonsalves, who recently wrote the following in response to the backlash against funding HIV: “So when people say, ‘oh we can’t afford to treat people with HIV. It’s becoming an entitlement,’ we need to reflect on this abject terror: ‘we have what it takes to keep you alive, but we won’t pay for it. Your family is going to watch you die.’

“That’s what it was like eight or nine years ago, that’s what it was like in the United States 15 years ago. We need to tell people when they turn around and say, ‘we just need to spend on prevention,’ that this is what they actually mean,” Venter added. “You’re going to take people [with HIV] and send them back to their families to die and that is not acceptable.”