Progress Made in Fight Against Tuberculosis, WHO Says on World TB Day; MSF Disagrees, Calls for Increase in Efforts
The World Health Organization on Tuesday in a report marking World Tuberculosis Day said that the agency is "gaining ground" against TB, but Medicins Sans Frontieres said that the world is "losing the battle" against the disease, Reuters reports (Nebehay, Reuters, 3/24). The eighth annual report, titled "Global Tuberculosis Control -- Surveillance, Planning, Financing," includes data on case notifications and treatment outcomes from all national TB programs that have reported to WHO and an analysis of plans, budgets, expenditures and constraints on "directly observed treatment, short course," or DOTS, expansion for 22 "high-burden" countries (WHO Web site, 3/24). The report was released in New Delhi, India, at the 2nd Stop TB Partners Forum, which includes a week of meetings between health ministers from the 22 countries that account for 80% of the world's TB cases, aid agencies, not-for-profit groups and technical experts to create a strategy to meet the goal of diagnosing 70% and curing 85% of all TB cases by 2005, the Washington Post reports.
The new report, which covered a total of 210 countries, includes data through 2002 and found that the total number of active TB cases increased 2.4% that year, "driven" by an increase in the world population and a "slight increase" in the per capita incidence of the disease, according to the Post. WHO also found that about 3.9 million cases were diagnosed "with certainty," meaning the cases were confirmed by growing the bacterium in a culture or seeing it under a microscope, the Post reports. Other cases were diagnosed solely based on symptoms. WHO in the report said that 180 DOTS programs have been established worldwide -- an increase of 25 programs over 2001 -- and 69% of the world's population had access to DOTS treatment in 2002 (Brown, Washington Post, 3/24). The report also found that 82% of TB patients who received DOTS treatment were cured of the disease; however, only 37% of infectious TB cases were detected and treated through DOTS programs, USA Today reports (Manning, USA Today, 3/22).
MSF, HIV and TB
MSF in a statement said that the world is "losing the fight" against TB because it is using "outdated" tests and drugs, Reuters reports. The group said that the diagnostic test for TB was invented during the 1800s and only identifies 50% of TB cases among patients who also have HIV. The group called for increased funding for the development of new TB medicines and "more efficient ways of detecting the infectious disease," according to Reuters. MSF said, "We are losing the battle against tuberculosis because we rely on archaic diagnostic tests and drugs" (Reuters, 3/23). According to some experts, TB incidence would be decreasing if there was no HIV, according to the Post (Washington Post, 3/24). MSF International President Rowan Gillies said, "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." He added that the effectiveness of "first-line" drugs in treating patients are based on a patient strictly adhering to treatment for between six and eight months, according to Reuters (Reuters, 3/23). But Catherine Watt of WHO's Stop TB program said, "It is thought that with currently available drugs and the DOTS control strategy, the tuberculosis epidemic can be controlled," adding, "Nonetheless, there is ongoing research into new drugs and new diagnostic tools in order to speed and improve control" (Reuters, 3/24).
Oliver Brouant, head of MSF's TB project in Mumbai, India, said, "Surely we can do better than this" (Reuters, 3/23). Anne Peterson, assistant administrator of the Bureau for Global Health at USAID, said that the U.S. contribution to the fight against TB has increased "for several years" and likely will continue to increase, according to USA Today. She added, "We have moved from $10 million in 1998 to $75 million in 2003, and we're hoping to get $82 million in 2004." She also said that funding for TB control could come from President Bush's Emergency Plan for AIDS Relief because TB is the leading cause of death among HIV-positive people in the developing world, according to USA Today. Stop TB Director Mario Raviglione said, "It's a public health issue. We need to link these two epidemics" (USA Today, 3/22). In addition, the "overlap" of HIV and TB is being used as a way to target people to be treated under WHO's 3 by 5 Initiative, which aims to treat three million HIV/AIDS patients with antiretroviral drugs by 2005, the Post reports. WHO Assistant Director-General Jack Chow said, "We see DOTS systems as a platform to reach out into the HIV community" (Washington Post, 3/24).
The nongovernmental groups Massive Effort Campaign, RESULTS and Saahasee on Tuesday released their "Global TB Report Card," which says that 33% of the world's TB cases are found in countries that are not doing enough to combat the disease, the AP/Las Vegas Sun reports. The report card, which is based on the findings of the WHO report, determined each country's performance in following the DOTS strategy for treating TB. The report card shows that Russia, Brazil, Nigeria, Ethiopia, China and Thailand are "making minimal use of effective strategies" to control TB, according to the AP/Sun. The report card also says that Bangladesh, Indonesia, Afghanistan and Pakistan are "lagging behind" but showing some improvement in the fight against the disease. The report card also notes that Vietnam -- which has cured 76% of TB cases using DOTS -- is a "rare bright spot." Although India has cured a "much smaller percentage" of TB patients compared with Vietnam, India has made "rapid improvements," according to the report card. "India has contributed the most to the global expansion of TB control in the last four years, and other countries need to follow its lead," Bobby John of Massive Effort said, adding, "In countries where progress in controlling TB has stalled, people must ask their leaders why they are failing to combat this curable disease" (AP/Las Vegas Sun, 3/23).