But urgent effort and funding still needed to stem the double burden of TB and HIV in sub-Saharan Africa.
The World Health Organization (WHO) has announced the achievement of a significant milestone in global efforts to fight the resurgent epidemic of tuberculosis. More than 10 million tuberculosis (TB) patients have now been successfully treated under DOTS, the internationally recommended TB control strategy. Of these, more than 90 percent live in developing countries where the disease causes the most suffering, economic loss and death.
The announcement comes 10 years after WHO declared TB a "global emergency." "The treatment and cure of so many people under DOTS has saved millions of lives and is slowing the spread of infection," said Gro Harlem Brundtland, director-general of WHO. "But now we must accelerate our efforts. With additional funding for TB control programs, especially in the 22 high-burden countries that account for 80 percent of global cases, we could expect to see a world-wide reduction in the sickness and death caused by TB within three years. "
According to the WHO Global Tuberculosis Control Report for 2003, growth in the global incidence rate of TB has slowed to 0.4 percent per year. The number of countries that have adopted the DOTS strategy has grown to 155 (of 192 WHO Member States) and more than 60 percent of the world's population now has access to DOTS services. China and India, which together account for nearly 40 percent of all TB cases, have made remarkable progress in quickly expanding population coverage while maintaining high cure rates.
However, the WHO report found the TB epidemic is still growing unabated in sub-Saharan Africa where it is closely linked to HIV/AIDS and poverty and in many of the newly independent states arising after the break-up of the Union of Soviet Socialist Republics, where it is exacerbated by poverty and social disruption. In some high-HIV countries of sub-Saharan Africa, TB rates have quadrupled since the mid-1980s and threaten to overwhelm well-established control programs.
"TB and HIV have become intertwined epidemics, increasing their devastating impact on communities world-wide," said Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Effectively treating TB will not solve the AIDS crisis, but will save lives and ultimately reduce the burden of AIDS on societies."
WHO and the Stop TB Partnership are demonstrating through the “ProTEST” projects in Malawi, South Africa and Zambia, how TB and HIV workers can collaborate effectively to strengthen DOTS for people with HIV, to find cases of TB earlier and to provide preventive therapy. As the world moves increasingly to extend the lives of people living with HIV through provision of antiretroviral medicines, the same approach provides an excellent platform for delivering DOTS.
Reversing the growing burden of major communicable diseases, particularly HIV/AIDS, malaria and TB are among the Millennium Development Goals adopted unanimously in 2000 by all members of the United Nations. High burden countries are putting considerable funding and expertise into defeating TB, with positive, verifiable results. At the same time, Stop TB Partnership members such as the World Bank, the U.S. Agency for International Development, the Canadian International Development Agency, the UK's Department for International Development, the governments of Japan and the Netherlands and others are closely cooperating to identify and meet funding gaps in the Global Plan to Stop TB for 2001-2005.
Successes in Battling TB
Examples of a number of major success stories at country level in recent years demonstrate that TB control programs are working to turn the tide against the TB epidemic:
- In India, more than one million TB patients have been treated under DOTS since DOTS expansion began in late 1998 and 50,000 new patients are now started on treatment every month. By early 2002 the DOTS program was credited with saving 200,000 lives and more than $400 million in indirect costs.
- In China, second on the list of High-Burden Countries, 1.3 million people with infectious TB have been treated under DOTS over the last decade and 90 percent of them cured. As a result, active TB cases have fallen 35 percent in areas applying DOTS since 1993 compared to a small increase in areas not covered. The DOTS expansion programs in both China and India were supported with loans from the World Bank.
Two high-burden countries, Vietnam and Peru, have already exceeded the global TB control targets for 2005 of identifying 70 percent of all TB cases and curing 85 percent of those identified. As a result, Peru fell off the list of High Burden Countries in 2000 and TB cases are now falling by 6 percent annually. The Philippines, Myanmar and Cambodia are all making strong headway and within reach of the 2005 targets.
World Health Organization (WHO)