• Fighting Tuberculosis

    The global tuberculosis epidemic

    Globally, TB is a leading cause of death from an infectious disease worldwide, second only to AIDS. It is also known as a disease of poverty, affecting mainly young adults in their most productive years, with two-thirds of cases estimated to occur among people aged 15-59. In 2011 there were 8.7 million new cases of TB and 1.4 million deaths (this includes 430,000 deaths among people who were HIV-positive). The vast majority of deaths from TB –over 95 percent - are in the developing world.

    The latest report released by the World Health Organization (WHO) in 2012 shows that all six WHO regions are on track to achieve the Millennium Development Goal (MDG) target of falling TB incidence rates by 2015. Worldwide, mortality from TB has fallen by 41 percent since 1990. Despite this progress, the global burden of TB remains enormous.

    Tuberculosis prevention and treatment

    Progress in tackling the global TB burden is associated with DOTS, the basic package that underpins the Stop TB Strategy, which was adopted by 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. Countries that have adopted this strategy have successfully treated a total of 51 million people since 1995.

    The Global Fund has helped to accelerate case detection and successful treatment in recent years, with 9.7 million cases of smear-positive TB detected and treated by Global Fund-supported programs between 2002 and end 2012. The Global Fund provides almost 90 percent of all international financing for TB.

    Challenges to reversing the spread of tuberculosis

    The last five years have seen an increase in the number of TB patients diagnosed with multidrug-resistant TB. The spread of this form of TB has greatly accelerated in recent years, but testing and treatment uptake remain low. In ten years, Global Fund-supported programs have treated 64,000 cases of multidrug-resistant TB, but this is only a small percentage of the estimated need. In 2011, only 19 percent of estimated multidrug-resistant TB cases were treated globally. Coverage of diagnostic testing for multidrug-resistant TB remains low, but a new rapid diagnostic test has recently been introduced on the market and is quickly being adopted by countries.

    The HIV epidemic has fueled the TB epidemic, particularly in sub-Saharan Africa. In 2011 it was estimated that 1.1 million of new TB cases were co-infected with HIV. HIV and TB are a deadly combination, as each fuels the progress of the other in infected patients. Those who are HIV-positive are up to 30 times more likely to develop active TB than those who are not.

    Signs of progress

    Although TB remains a major public health concern, and the rise in multidrug-resistant and extensively drug-resistant TB is alarming, there are some signs of progress. As noted above, new diagnostic tools for detection have recently been introduced. Countries are making progress in implementing and scaling up TB/HIV collaborative activities, and research and development continues on new diagnostics, new drugs and new vaccines.