Stop TB Partnership Board meets in Washington, D.C. to take stock of disease’s burden 10 years after movement’s founding.
Despite 1.7 million TB deaths in 2009, there are many signs of progress; 13 of the highest-burden TB countries are set to meet MDG 6.
Bank support to India triples TB treatment rates; project in East Africa helps laboratories detect the disease.
March 31, 2011—Health ministers, United Nations and development agencies, nongovernmental organizations (NGOs), people living with tuberculosis (TB), doctors, and scientists on the global Stop TB Partnership’s Coordinating Board meet this week in Washington, D.C., to review progress on a historic commitment they made a decade ago to ‘eliminate tuberculosis as a global public health problem.’
The Stop TB Partnership, a network of international organizations, countries, and donors, was established in 2001, with the World Bank as one of its founding partners. As Board members meet today, a new report from U.N. Secretary Ban Ki-moon, released in Nairobi, Kenya, amplifies concerns about TB’s fatal twinning with HIV/AIDS and gives notice that the disease is far from vanquished.
A highly-contagious, airborne pathogenic bacterium, TB is one of the leading causes of death among women between 15-44 years of age. In 2009 alone, 1.7 million people died from TB-related illness, including 380,000 people with HIV―despite the fact that the disease is both preventable and curable.
In many African countries, people living with AIDS frequently succumb to TB as a final, deadly opportunistic infection, making AIDS and TB a particularly dangerous co-epidemic. In 2010, multidrug-resistant TB (MDR-TB) rates were reported to be at their highest levels ever. Extensively drug-resistant TB cases were reported in 58 countries.
Signs of Progress
The short-term goal of the Stop TB movement is to help countries meet the 2015 Millennium Development Goal (MDG) 6 pledge of halting and beginning to reverse TB incidence by 2015, in comparison with 1990 levels. In fact, many countries report that they are on track to meet this goal. Globally, the percentage of people successfully treated for TB has reached its highest level, at 86%, and of the 22 countries worldwide with the highest TB burden, 13 of them are on closing in on their MDG 6 TB targets.
There are signs of progress in both developing new drugs to treat TB and in detecting the disease.
The 2010 Report on Tuberculosis Research Funding Trends, 2005–2009, issued by the Stop TB Partnership and the Treatment Action Group, reported that in 2010, at least four novel classes of drugs are in clinical trials to treat TB, and there is unprecedented interest in accelerating the development of novel TB combination regimens using regulatory science. As recently as 2005, no new class of drugs to treat TB had been approved since the 1970s.
In addition, the U.S. Food and Drug Administration and the European Medicines Agency have provided new guidance that may facilitate the approval of one or two new TB drugs in the coming 12 to 18 months. Also on the horizon are a set of novel candidate TB vaccines, some of which may be ready for large-scale field trials in the coming five years.
On the detection front, a technology breakthrough for Africa came last week on World TB Day when South Africa’s Health Minister, Dr. Aaron Motsoaledi, unveiled the continent’s first GeneXpert device at Durban’s Prince Mshiyeni Memorial Hospital. The GeneXpert can detect TB and multi-drug resistant TB (MDR-TB) in two hours, a remarkable feat given the usual 3-12 weeks it currently takes to “ culture TB”, the currently used method to detect MDR-TB.
Africa’s TB-HIV Challenge
In East Africa, which is assailed by high rates of co-infection of TB and HIV, the World Bank is helping four countries—Kenya, Rwanda, Tanzania, and Uganda—establish a regional network of public laboratories to improve access to high-quality diagnostic services among vulnerable populations living in the cross-border areas of all four countries.
The $63.7 million project—launched in May 2010 with support from U.S. Centers for Disease Control, the World Health Organization, the U.S. Agency for International Development, and the International Union against Tuberculosis and Lung Disease—helps laboratories produce accurate and rapid diagnostic results that are not only vital to detecting TB, but will also increase the chances of survival among patients suffering from cholera, meningitis, and Rift Valley fever. Historically, laboratories have been a weak link in sub-Saharan African health systems, hindering governments’ ability to confirm and respond in a coordinated way to outbreaks of disease.
India’s Treatment Rates Soar
The Bank’s anti-TB efforts have also helped India, which carries 20% of the world’s TB burden. Since the Bank began supporting India TB control, treatment success rates have tripled from 25% to 86%. TB death rates have decreased seven-fold from 29% to 4%; about 1.7 million additional lives have been saved.
Currently, Bank zero-interest financing is being used to buy drugs, expand laboratory capacity, and train community health workers. Seven million people have been screened for TB, and 780,000 have been successfully treated.
Fight Goes On
Even with welcome progress in recent years, the fight goes on. As U.N. Secretary-General Ban Ki-moon warned last week on World TB Day, without additional funding in the battle against TB for research, improved prevention, early diagnosis and treatment, some 8 million people will die from what is largely a curable disease between now and 2015.
"There is cause for optimism," he said, “at the same time our hope must be tempered by the sobering fact that multi-drug-resistant forms of tuberculosis (MDR-TB) remain an ever-present threat that, if allowed to spread unchecked, could set back the steady progress made during the past two decades… Without further improvements in tuberculosis prevention, early diagnosis and treatment, some 8 million people will die of tuberculosis between now and 2015."