Worldwide efforts to confront tuberculosis making progress, but slowly

The World Health Organization (WHO) report, Global Tuberculosis Control 2008, released in Geneva Monday, finds that the pace of the progress to control the tuberculosis (TB) epidemic slowed slightly in 2006, the most recent year for which data were available. The new information documents a slowdown in progress on diagnosing people with TB. Between 2001 to 2005, the average rate at which new TB cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase was cut in half, to 3%.

The reason for this slowing of progress is that some national programmes that were making rapid strides during the last five years have been unable to continue at the same pace in 2006. Moreover, in most African countries there has been no increase in the detection of TB cases through national programmes. Other studies have also shown that many patients are treated by private care providers, and by non-governmental, faith-based and community organizations, thus escaping detection by the public programmes.

“We’ve entered a new era,” said Dr Margaret Chan, WHO Director-General. “To make progress, firstly public programmes must be further strengthened. Secondly, we need to fully tap the potential of other service providers. Enlisting these other providers, working in partnership with national programmes, will markedly increase diagnosis and treatment for people in need.”

This is the twelfth annual WHO report on global TB control, and is based on data given to WHO by 202 countries and territories.

There were 9.2 mln new cases of TB in 2006, including 700,000 cases among people living with HIV, and 500,000 multi-drug resistant TB (MDR-TB). An estimated 1.5 mln people died from TB in 2006. Another 200,000 people with HIV died from HIV-associated TB.

The report highlights two aspects of the epidemic that could further slow progress on TB. The first is multidrug-resistant tuberculosis (MDR-TB), reported by WHO last month to have reached the highest levels ever recorded. To date, however, the response to this epidemic has been inadequate.

The second threat to continued progress is the lethal combination of TB and HIV, which is fuelling the TB epidemic in many parts of the world, especially Africa. The three African countries achieving the highest HIV testing rates in TB care settings in 2006 were Rwanda (76%), Malawi (64%) and Kenya (60%).

The report also documents a shortage in funding. Despite an increase in resources, especially from the Global Fund and some middle-income countries, TB budgets are projected to remain flat in 2008 in almost all of the countries most heavily burdened by the disease. Ninety countries in which 91% of the world’s TB cases occur provided complete financial data for the Report. To meet the 2008 targets of the Global Plan to Stop TB, the funding shortfall for these 90 countries is about US$ 1 bln.