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The Global Fund / Tanya Habjouqa

Tuberculosis is the world’s leading killer amongst infectious diseases. In 2017, TB killed 1.6 million people, including 300,000 people with HIV, making it one of the top 10 causes of death worldwide.

TB is spread from person to person through coughing and sneezing. One person with active, untreated TB can spread the disease to as many as 15 other people in a year. This makes the hunt for “missing cases” – those people currently not diagnosed, treated or reported – all the more urgent. With an estimated 10 million new cases of TB every year, we must accelerate progress.

Roughly 36 percent of people with active TB are missed each year. As long as millions of people live with the disease without treatment and continue to transmit the infection to others, the world will not end TB as an epidemic. This is why the Global Fund supports programs that address barriers to finding missing cases of TB, and expands the most successful tools and strategies. Among other things, this means adding TB screening to other routine check-ups during medical visits.

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The Global Fund / John Rae

Making TB screening routine can help reduce the stigma associated with the disease. Fear of being stigmatized often means people delay seeking help until seriously ill. Not only do they risk infecting those around them, but treatment takes longer and is less effective when the disease is in its advanced stages.

Key populations for TB

Prisoners, people living with TB/HIV coinfection, migrants, refugees and indigenous populations are highly vulnerable to TB, and experience significant marginalization, decreased access to quality services, and human rights violations. All people who have, or have survived, TB are considered as a key population for TB.

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The Global Fund / Tanya Habjouqa
The Global Fund / Nichole Sobecki

TB hunters

TB has stalked humanity for millennia. To turn the tables, we must turn to unconventional measures. Health partners in Tanzania have recruited an unlikely team of TB hunters: traditional healers, people recovering from drug use, and volunteer health workers who comb neighborhoods in the remotest parts of the country in search of the disease. Meet the people on the front lines of the fight.

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Drug-resistant TB

In most cases, TB is treatable and curable. However, standard TB treatment requires up to six months of drugs that can cause nausea, vomiting and stomach pain. The duration and side effects drive some people to abandon their treatment, which can lead to drug resistance – when TB bacteria is resistant to at least one of the main TB drugs. In 2017, there were 558,000 new cases with resistance to the most effective first-line drug, of which 82 percent had multidrug-resistant TB (MDR-TB).

Drug-resistant TB is part of the growing challenge of antimicrobial-resistant superbugs that do not respond to existing medications, resulting in fewer treatment options and increasing mortality rates for illnesses that would ordinarily be curable – including TB. Global development partners must move faster to contain this threat of antimicrobial resistance before it escalates to claim millions of lives around the world.

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TB and HIV

About one-quarter of the world’s population has latent TB, but only about 5 to 15 percent develop symptoms of active TB. Individuals with compromised immune systems – such as people living with malnutrition, diabetes, HIV, or who use tobacco – have a higher risk of developing active TB.

HIV and TB are a deadly combination, as each fuels the progress of the other in infected patients. TB is the leading killer of people living with HIV; about 40 percent of deaths among people with HIV are due to TB. Those who are HIV-positive are up to 30 times more likely to develop active TB than those who are not, which is why it is vitally important, particularly in countries with a high burden of TB, that services for HIV and for TB be integrated. Every person who is HIV-positive should be screened and monitored for TB, and every person diagnosed with TB also needs to be tested for HIV.

Progress in the response to TB

Progress is being made. The mortality rate for TB fell by 42 percent between 2000 and 2017. The Global Fund provides more than 65 percent of all international financing for TB. We have disbursed more than US$5.9 billion as of end 2017.

The development of new diagnostic tools such as the GeneXpert [ download in English ] machine has greatly aided the response to multidrug-resistant TB. The number of people treated for drug-resistant forms of TB through Global Fund-supported programs in 2017 was more than 105,000 – a significant increase from a decade ago. New drugs are also being introduced, particularly for MDR-TB, which have the potential to reduce the burden on both national health budgets and the patients – but the R&D development pipeline is thin.

Senegal: Tracing TB

In 2017, 10 million people worldwide fell ill with TB. Thirty-six percent of them were never reported, diagnosed or treated – they are the “missing” people with TB. This video highlights the rise of community-based organizations on the frontlines to find missing people with TB in Senegal. Thousands of volunteers screen the hardest-hit neighborhoods in search of people who may be ill. Their mission is critical: if people with active TB don’t receive treatment, they won’t survive – and they can infect others.

Published 20 September 2018