Tuberculosis is the world’s leading infectious disease killer, preying on poor and marginalized communities. Every day, close to 4,000 people around the world lose their lives to TB, and an estimated 10 million people fell sick with the disease in 2019 alone. Because it also attacks the lungs, COVID-19 is especially concerning for people with TB and threatens to cause even greater illness. We must #UniteToFight both diseases.
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.
In partnership, we are making progress to end the disease as an epidemic. The number of people treated for TB has grown to over 14 million in 2018 and 2019. People provided with TB preventive treatment has also quadrupled since 2015, from 1 million in 2015 to over 4 million in 2019.
COVID-19 threatens to devastate the fight against TB. First because the lungs of people with TB are already damaged, making them especially vulnerable to the respiratory stress of COVID-19.
Second, the pandemic is causing a sharp drop in TB identification and treatment, especially in high TB burden countries. With many laboratory services under acute pressure, new TB case notifications in some places have dropped by up to 75%. This is particularly concerning as identifying and treating the estimated 3 million TB patients who are “missed” every year is vital to ending the epidemic.
Models from the WHO suggest that a 50% drop in TB case detection over three months could result in 400,000 additional TB deaths in 2020 alone. At the Global Fund, we are leading a global effort - #UniteToFight - to protect decades of hard-won progress and save more lives. Get the latest on our COVID-19 response.
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.
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.
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.
About one-quarter of the world’s population has latent TB, but only about 5 to 15% 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% 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.
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 2018, about 500,000 people became ill with drug-resistant TB with only about 56% completing treatment successfully.
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.
The Global Fund provides 73% of all international financing for TB and has disbursed US$10.3 billion for TB programs (including TB/HIV programs) as of August 2020. In 2019, 5.7 million people with TB were treated in countries where the Global Fund invests.
The absolute number of TB deaths among HIV-negative people fell 27% between 2000 and 2018, from a best estimate of 1.7 million in 2000 to 1.2 million in 2018, and the mortality rate fell by 42%. Among HIV-positive people, the number of TB deaths fell by 60%, and the mortality rate fell 68%.
The development of diagnostic tools such as the GeneXpert machine has greatly aided the response to multidrug-resistant TB. The number of people treated for drug-resistant forms of TB in Global Fund-supported countries in 2019 was more than 12,514,000 – 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.
Published 14 September 2020