War against stubborn TB

An estimated 14 million people worldwide are infected with active tuberculosis (TB), which is a disease of poverty affecting mainly young adults in their most productive years. In 2009, there were 9,4 million new cases of TB and 1,7 million deaths, including 380 000 deaths from TB among people with HIV.

The vast majority of deaths from TB are in the developing world. The latest data released by the World Health Organisation (WHO) in November 2010 show that the number of new cases continues to fall globally and in five of the six WHO regions.

The exception is South-east Asia, where incidence remains stable. In many countries TB prevalence is declining.
Worldwide, deaths from TB fell by 35 percent between 1990 and 2009. If current trends continue the world can meet the Millennium Development Goal target for incidence – that new cases should be falling by 2015 – and the Stop TB Partnership target to halve TB mortality by 2015 in comparison with 1990.

Prevention and cure

Progress in tackling the global TB burden is associated with DOTS, the basic package that underpins the Stop TB Strategy, which was adopted by the WHO in 1993. The expansion of DOTS across the world since the mid-1990s is tracked through the proportion of estimated new TB cases that are detected – or “notified” – and successfully treated under DOTS.

In 2009 5,8 million cases of all kinds of TB were notified globally, equivalent to a 63 percent case detection rate compared with 61 percent in 2008. Treatment success rates continue to be measured in terms of smear-positive pulmonary TB only. Of the 2,6 million cases notified in 2008, 86 per cent were successfully treated against the new 90 percent target included in the 2011-2015 update of the Global Plan to Stop TB.

A total of 41 million TB patients were successfully treated in DOTS programs between 1995 and 2009. The Global Fund has helped to accelerate case detection and successful treatment in recent years, with 1,7 million additional cases of TB detected and treated by Global Fund-supported programs in 2010, compared with 1,4 million in 2009 and 1.3 million in 2008. Since the Global Fund’s inception in 2002, programs it has financed had supported DOTS for a total of 7.7 million people by December 2010.

Challenges to reversing the spread of tuberculosis

The incidence of new cases worldwide is falling too slowly at around 1 percent per year.

Drug-Resistant TB is on the increase, particularly in Eastern Europe and parts of Asia.

Levels of case detection and successful treatment are far too low. Only 12 percent (30,000) of the estimated cases were notified in 2009 and less than 5 percent were properly treated.

The Global Fund is the major donor for responses to Drug-Resistant TB. Programs it supports treated 14,000 cases in 2009, equivalent to nearly 60 percent of the 23,000 enrolled for treatment globally that year, and an additional 13,000 in 2010 – bringing the total treated with Global Fund support to 43,000 at December 2010.

The HIV epidemic has fuelled the TB epidemic, particularly in sub-Saharan Africa.

Too little is done to prevent TB among people living with HIV, who account for 13 percent of the new TB cases in 2009. Less than 1 percent of the estimated number of people living with HIV worldwide received isoniasid preventive therapy in 2009 and only 26 percent of TB patients knew their HIV status.

Service coverage for TB/HIV co-infections remains very low.

By December 2010, Global Fund-supported programs had provided a total of 2,4 million TB/HIV services.

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