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2005 Global TB Report Card Finds TB Control Stalled in Africa HIV Is Overwhelming Africa with TB Cases
Results International
2005-03-29
An overwhelming number of tuberculosis (TB) cases in Africa unleashed by HIV are frustrating efforts to reverse the global TB epidemic, according to an independent report issued today by the Massive Effort Campaign and RESULTS International, based on new data published by the World Health Organization.
The number of TB cases globally would be declining now
were it not for our failure to fully support TB control efforts in sub-Saharan
Africa, said Dr. Joanne Carter, legislative director for RESULTS
International. Despite the hard work of many TB programs, the TB-HIV epidemic
is overwhelming efforts in many nations and programs are often not receiving the
political priority and resources they deserve. According to the report, seven
African countries and the Russian Federation are making the slowest progress in
controlling tuberculosis among countries with the greatest number of cases. In
Africa this is largely because HIV is rapidly increasing TB caseloads. In
Russia, the epidemic is being driven by high rates of multi-drug resistant (MDR)
TB and delays in extending DOTS services to vulnerable populations.
People infected with the TB bacteria are 50 times more
likely to become ill with TB once their immune systems are weakened by HIV, said
Dr. Carter. In many African countries severely affected by HIV/AIDS, TB cases
have more than tripled in the past decade. TB is now the number one
opportunistic infection for people who are HIV-positive and the leading killer
of people with AIDS. Still, TB can be cured in most people regardless of their
HIV status. A million Africans living with HIV will likely die from TB in the
coming years if donors and national leaders fail to make providing effective TB
treatment a priority, said Winstone Zulu, a Zambian activist living with HIV
who nearly died from TB. The only reason Im alive and now able to benefit
from antiretrovirals is because I was first able to get that 10 worth of TB
medicines.
According to the 2005 Global TB Control Report Card, TB
control efforts are stalled in seven of the nine African countries with the
largest burden of TB. In Uganda, 10 percent fewer infectious TB patients were
detected and cured with DOTS TB treatment services in 2003 compared to four
years before, in spite of the countrys much heralded success in slowing the
spread of HIV. In Nigeria, 105,000 people died of TB last year more than any
other African country as its TB control programme has struggled without
sufficient government commitment and donor resources. By contrast, the
Democratic Republic of the Congo has expanded its TB control efforts to cure 9
percent more cases of infectious TB in 2003 than in 2000, despite absolute
poverty, a high incidence of HIV and chronic civil conflict. Afghanistan,
another country plagued by civil strife, is also making impressive progress in
controlling TB.
Many large Asian countries are succeeding in curing more
TB patients with the DOTS strategy, including Myanmar, Philippines and Thailand
which have cured nearly 20 percent more cases over the past four years and India
which has achieved an astounding 31 percent increase over the same period. The
2005 Global TB Control Report Card also commends Indonesia and Pakistan for
making rapid progress in curing more infectious TB cases with the DOTS strategy.
The Report Card notes that many of the worlds poorest countries are making
greater progress in controlling TB than some wealthier countries. Cambodia and
Viet Nam, for example, have extended use of the DOTS strategy to cure 50 percent
to 80 percent of all infectious TB cases respectively. By contrast, Brazil and
Russia are providing DOTS services to cure less than 15 percent of estimated TB
cases.
Worldwide, over a third of all people with infectious TB
were detected and cured with high quality DOTS treatment services in 2003, the
most recent year for data. This represents a remarkable increase since 1996,
when only one out of every 10 people were being detected and cured with DOTS.
But in spite of these efforts, the TB epidemic is still growing. Nearly
two-thirds of patients with infectious TB are not receiving adequate treatment
and just a tiny fraction of those with MDR-TB are being adequately diagnosed and
treated through DOTS-Plus programs. In addition, many of those co-infected with
TB and HIV are missed by current diagnostic methods, further driving the
co-epidemic.
Tuberculosis was last years most overlooked
tragedy, said Dr. Bobby John, president of the Massive Effort Campaign. TB
killed more people than all wars, earthquakes, floods, tsunamis, airline
accidents, terrorist acts and murders worldwide the past year, but with much
less fanfare. The deaths of these 1.8 million people were arguably all the more
tragic as almost every one of them could have been prevented with proper
treatment. The Massive Effort Campaign and RESULTS International are calling
on donors to fully meet the resource requirements of the Global Fund to Fight
AIDS, TB and Malaria so that it can finance all worthy grant applications for TB
control in Africa during 2005, as well as to increase funding for the World
Health Organizations TB control programme, the Stop TB Partnership and the
Global TB Drug Facility, in order to provide additional technical and drug
procurement support to the worst affected countries.
TB can be controlled in even the most adverse
settings, provided there is global and national political will, adequate
technical assistance and ample donor support, said Dr. John. At least half
of the 22 countries with the highest TB burden have been failing in want of
this. Hopefully, next years report card will be able to tell a much better
story.
(Source: Results International, March 24, 2005)
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