TB Rates Decline Overall Worldwide; Disease Remains Primary Cause of Death Among HIV-Positive Africans, WHO Says
Efforts to curb the spread of tuberculosis worldwide are making "gradual headway," but "serious problems" remain in combating the disease in Africa and among people living with HIV/AIDS, according to a World Heath Organization report released on Thursday in observance of World TB Day, AFP/Yahoo! News reports. In its annual report, titled "Global Tuberculosis Control -- Surveillance, Planning, Financing," WHO estimated that in 2003 -- the latest year for which data are available -- there were approximately 8.8 million new cases of TB worldwide. However, only 3.9 million of these cases were diagnosed through laboratory tests, and 674,000 of the cases occurred among HIV-positive people (AFP/Yahoo! News, 3/23). The global TB prevalence rate has declined by more than 20% since 1990, and TB incidence rates in 2003 were falling or stable in five of the six WHO regions of the world. However, as of 2003, the global TB incidence rate was growing by 1%, primarily because of increasing incidence in the African region. Since 1990, TB incidence rates in Africa have tripled in countries with high HIV prevalence and are increasing continent-wide at a rate of 3% to 4% annually, according to a WHO release (WHO release, 3/24).
There were approximately 1.7 million TB-related deaths worldwide in 2003, nearly one-third of which occurred in Africa, where HIV/AIDS and TB "form a deadly combination" and TB is the leading cause of death among HIV-positive people, according to Reuters (Nebehay, Reuters, 3/23). Of the 22 countries most affected by TB, nine are in Africa. However, control efforts have "stalled" in seven of these countries -- Ethiopia, Kenya, Mozambique, Nigeria, Uganda, Tanzania and Zimbabwe, AFP/Tribune de Geneve reports. "The overwhelming conclusion from the report card is that Africa is where we're facing the biggest challenge and the biggest trouble," Don Enarson, director of the International Union Against Tuberculosis and Lung Disease, said, adding, "It's the African community that's suffering and dying, and I think this is a scandal that we cannot continue to live with." Although some countries with the highest TB burdens received "glowing reports," others were said to be doing "conspicuously little" to combat the disease, according to AFP/Tribune de Geneve. In Nigeria, approximately 105,000 people died of TB-related causes last year, and there was a 10% drop in Uganda's detection and cure rates between 1999 and 2003, according to AFP/Tribune de Geneve (AFP/Tribune de Geneve, 3/24). The report found that inadequate health care and a lack of medical personnel across much of Africa also hinders efforts to control TB on the continent. "Paradoxically, you can have all the finances you need, but if you don't have the people to implement those things, ... then you are really stuck," Mario Raviglione, director of WHO's Stop TB department, said, adding that African leaders need to become increasingly involved in TB control efforts (Ross, AP/Yahoo! News, 3/24).
Asia, Eastern Europe
WHO Director-General Jong-Wook Lee at a press conference said there has been "tremendous improvement" in curbing TB in India and China, where increasing numbers of people are receiving treatment. The two countries accounted for 35% of new TB cases worldwide in 2003, with an estimated 1.8 million new cases in India and 1.3 million in China. According to Raviglione, the successes in India and China can be attributed to the combination of governmental support and financial resources from donor nations (Reuters, 3/23). TB incidence also has been decreasing in Eastern Europe since 2001 (AFP/Yahoo! News, 3/23). However, the high rates of multi-drug-resistant TB strains in the region, particularly in Russia, have become a "global concern," according to Lee Reichman, director of the National Tuberculosis Center at the University of Medicine & Dentistry of New Jersey, USA Today reports (Manning, USA Today, 3/24).
More than 17 million TB patients between 1995 and 2003 received treatment under the WHO-recommended TB control strategy, called DOTS -- or directly observed therapy, short-course -- according to the report. Currently, 182 countries have adopted the DOTS strategy, which aims to improve diagnosis rates. The U.N. Millennium Development Goals have set a TB detection target rate of 70% in 2005; however, in 2003, less than 45% of infectious TB cases were detected. Funding for fighting the disease is increasing in developing countries, according to WHO. About $2.2 billion is needed this year to combat TB, with low- and middle-income countries needing $1.3 billion of that amount, according to AFP/Yahoo! News. About $1.2 billion already has been raised because of additional government funding in China, Indonesia and Russia and grants from the Global Fund To Fight AIDS, Tuberculosis and Malaria (AFP/Yahoo! News, 3/23).
"The goal of stopping and reversing TB is achievable," Lee said, adding, "The methods, procedures and supplies needed are well-known. They are getting impressive results wherever they are being used. The challenge now is to invest enough so that they can be used in Africa" (AP/Yahoo! News, 3/24). Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Christine Sizemore, acting chief of the tuberculosis and other mycobacterial diseases section in NIAID's Division of Microbiology and Infectious Diseases, said in a statement, "The WHO report reminds us that although existing control strategies to combat and treat TB are often successful, [TB] inevitably develops resistance to anti-TB drugs, underscoring the need for new medications and other strategies to keep pace with this formidable microbial foe. Large numbers of drug-resistant, and sometimes untreatable, TB cases could undermine improvements that the global community has made in tuberculosis control" (NIAID release, 3/24). Anglican Archbishop of Cape Town, South Africa, Njongonkulu Ndungane on Wednesday said that because of its association with HIV/AIDS, TB is being stigmatized and preventing people from seeking treatment. "There is growing concern about the stigmatization of TB because of its association with HIV. It is important that this is stopped," he said in a statement, adding, "This is unacceptable. TB can be cured. HIV can be managed. Both are diseases like any other" (South African Press Association, 3/23).