Fighting Tuberculosis

• 6 million new cases of infectious tuberculosis were detected and treated
• 48% of the 2009 estimated international targets for detection of TB cases and treatment using DOTS were contributed by Global Fund supported programs

The Global Tuberculosis Epidemic

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mycobacterium tuberculosis (MTB). It affects mainly the lungs, but also can affect any other organ in the body.

More than 2 billion people, one-third of the world's population, are infected with TB bacilli, over 90 percent of them in developing countries. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006.

Due to a combination of economic decline, the breakdown of health systems, insufficient application of TB control measures, the spread of HIV/AIDS and the emergence of multidrug-resistant TB (MDR-TB), TB is not declining in many developing and transitional economies.

TB and HIV

HIV and TB form a lethal combination, each speeding the other’s progress. People who are HIV-positive and infected with TB are up to 50 times more likely to develop active TB disease in their lifetime than people who are HIV-negative and infected with TB.

In 2006, more than 700,000 people living with HIV were infected with TB, and 200,000 HIV-positive people died from TB. Africa accounted for 85 percent of the estimated global HIV-positive TB cases.

Impact on Women and Children

Globally, men account for a higher proportion of notified TB cases (64 percent). However, TB is a leading cause of death among women of reproductive age.

Studies in various countries have shown that progression from TB infection to disease is likely to be faster for women compared with men in their reproductive years, and faster for men after 40 years of age.

Children are particularly vulnerable to TB because of frequent household contact.

Regional Impact

Since 2003, the number of new cases per capita has been slightly falling in all regions except the European Region, where rates are approximately stable.

In 2007, the African, South-East Asia and Western Pacific regions accounted for 83 percent of total TB cases. India, China, Indonesia, South Africa and Nigeria rank highest in terms of absolute numbers of cases. The African Region has the highest number of new cases per capita (363 per 100 000 population).

The vast majority of TB deaths are in the developing world, with more than half of all deaths occurring in Asia.

Drug Resistance to TB

Multidrug-resistant TB is a form of TB that is difficult and expensive to treat and fails to respond to standard first line drugs. Extensively drug-resistant TB occurs when resistance to second-line drugs develops on top of multidrug-resistant TB. It is virtually untreatable.

In 2006, there were an estimated half-a-million cases of multidrug-resistant TB. In 2008, WHO reported the highest rates of multidrug-resistant TB ever recorded, with peaks up to 22 percent of new TB cases in some settings of the former Soviet Union. Extensively drug-resistant TB cases have been confirmed in more than 45 countries, and in all regions of the world.

Social, Economic, and Development Impact

TB is a disease of poverty; affecting mostly young adults in their most productive years. It is the poorest people from the poorest countries who are most affected. Not only are they more vulnerable to the disease, because of their living and working conditions, they are also plunged deeper into poverty as a consequence of TB.

More than 75 percent of TB-related disease and death occurs among people between the ages of 15 to 54 - the most economically active segment of the population. A person with TB loses, on average, 20 to 30 percent of annual household income due to illness.

TB is estimated to deplete the incomes of the world's poorest communities by a total of US$12 billion.  

Prevention and Care

TB infection can be prevented, treated and contained. WHO and the Stop TB Partnership recommend an approach to reducing the burden of TB in line with global targets called the Stop TB Strategy.

The Stop TB Strategy has six major components: (i) DOTS expansion and enhancement; (ii) addressing TB/HIV, MDR-TB and other challenges; (iii) contributing to health system strengthening; (iv) engaging all care providers; (v) empowering patients, and communities; and (vi) enabling and promoting research.

The first component of the strategy, DOTS, combines five elements: i) political commitment with increased and sustained financing; ii) case detection through quality-assured bacteriology; iii) standardized treatment with supervision and patient support; iv) an effective drug supply and management system; v) monitoring and evaluation system, and impact measurement.

Nearly 32 million TB patients were treated under DOTS between 1995 and 2008. The global average cure rate was 85 percent in 2006, with lowest levels in Africa (76 percent) and Europe (67 percent).

While funding for TB control has steadily increased since 2002, there was still a shortfall of US$ 1 billion in 2008 for the 90 countries with 91 percent of global TB cases.