March 24, 2010
In a statement marking World Tuberculosis Day, UNAIDS Executive Director Michel Sidibe "warned Wednesday that double infections of HIV and TB could become the next new epidemic," the Associated Press reports. Sidibe said, "I'm calling for serious attention to TB, and serious attention to TB-HIV co-infection" (Corder, 3/24).
"Left unchecked TB and drug resistant TB -- which knows no borders -- could spread and become an even more severe global health threat," Sidibe said in a statement. "The world has already committed to reducing new TB cases and deaths under Millennium Development Goal 6. However, I call on the HIV community to go one step further: We must commit to halving TB deaths in people living with HIV by 2015" (3/24).
Also on Wednesday, the Global Fund to Fight AIDS, Tuberculosis and Malaria Executive Director Michel Kazatchkine "said he hoped to win pledges of up to $20 billion over the next three years from national governments, but he was concerned that the global economic meltdown could make rich countries scale back their contributions," according to the AP. Kazatchkine's announcement comes ahead of an October 5 meeting, to be held at the U.N. headquarters, when donors will pledge funding for the next three-year period (3/24).
Almost 30 donors are meeting March 24-25 in The Hague "to review global heath progress and assess funding needs for the period 2011-2013," according to a Global Fund press release (3/24). According to the AP, Kazatchkine "said the [Global Fund] also aims to reduce the prevalence of tuberculosis to 124 out of every 100,000 people in 2015, from 164 now, although he said the world was 'clearly off track' in its fight against drug-resistant tuberculosis" (3/24).
TB in South-East Asia, Prisons Worldwide
Also on Wednesday, the WHO's Regional Office for South-East Asia released a report detailing tuberculosis control in the region, VOA News reports (Herman, 3/24).
The report (.pdf) said the disease is "one of the most serious health and developmental problems in the South-East Asia Region of WHO," which includes 11 countries. Each year, there are 3.2 million new TB cases in the region and approximately half a million deaths, according to the report. "The region accounts for over a third of the global TB burden. ... Of the 3.6 million people living with HIV in the region, roughly half are estimated to be co-infected with TB," the report notes (3/24).
WHO officials are concerned about the spread of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) in the region, VOA News reports. Jai Narain, WHO's regional director of communicable diseases, said effective TB control programs can stop the spread of difficult to treat strains. "The emergence of drug-resistant TB is also a reflection of the quality of TB control programs. MDR [multi-drug resistant] levels are indeed reversible once we have good quality TB control programs," Narain said.
XDR-TB cases have been detected in Bangladesh, India, Indonesia and Thailand, according to the news service (3/24). Though the report says "considerable progress continues to be made" in TB control in the region, other challenges, such as "uncertainties regarding sustainable financial and operational resources ... are slowing the planned expansion of interventions for TB-HIV and MDR-TB." It adds that more attention needs to be given to the "social, economic and behavioural determinants that impact TB" in order to successfully control the disease "in the longer term" (3/24).
On Tuesday, the International Committee of the Red Cross (ICRC) said failure to control TB in prisons worldwide could hamper efforts to prevent the spread of drug-resistant strains of the disease, CNN reports. According to ICRC, prisons in developing countries are "perfect incubators for new variations of the airborne disease because of overcrowding, poor nutrition and inadequate health services," CNN writes. The organization -- which has worked to curb TB in prisons in the Caucasus, Central Asia, Latin America and Africa -- "points to the success of efforts to bring the disease under control in Azerbaijan where infected inmates are now treated in a centralized prison hospital in Baku and a similar program in neighboring Georgia."
Nikoloz Sadradze, the head of ICRC's delegation in Baku, said: "When we started visiting prisons in Azerbaijan 15 years ago, we discovered that TB was killing around 300 inmates every year. By last year, the number of deaths had fallen to 20, thanks to prevention measures, improved screening and diagnosis, and medically supervised treatment and follow-up" (Hooper, 3/23).
"Experience has shown that improved living conditions, including ample doses of fresh air and a diet of healthful foods, a heightened awareness of how TB spreads, and a better understanding by patients of the severe side effects that TB drugs cause, can make a big difference," according to an ICRC press release. "The ICRC also recommends that authorities implement the World Health Organization's TB control strategy, known as DOTS, which requires government commitment, regular supplies of medication and observed treatment" (3/22).
Financial Times Examines TB Worldwide
The Financial Times features a special series called "Combating Tuberculosis."
In an overview article, the newspaper writes that "[t]oo many of the crude innovations which have saved lives for a century are still in use, when they should long ago have been superseded. And too few targets to reduce the burden of TB have been met. In much of the world, diagnostic techniques have barely changed: unreliable microscopic analysis and lengthy laboratory culture of germs."
Mario Raviglione, head of TB at the WHO, remains "cautiously optimistic," according to the article. "36m people have been cured since 1995, detection is rising and since 2004 we have been flattening the curve of new cases per capita," Raviglione said. "Those are signs of success."
The article examines "promising experimental medicines [that] have begun advanced clinical trials in patients, and helped catalyse unprecedented co-operation with regulators," as well as other efforts, including "public-private partnerships in the search for new diagnostic techniques, vaccines and more affordable, practical and effective drugs."
The Financial Times writes that TB is the "orphan of the 'big three' killer infectious diseases, with less attention or funding than either HIV or malaria. ... The U.S. has its bespoke President's Emergency Plan for AIDS Relief and the President's Malaria Initiative, but TB is subsumed into more general projects" (Jack, 3/23).
Summaries of other Financial Times stories in the series appear below.
One of the stories focuses on drug-resistant strains of TB. "The delays and difficulties of the treatment help explain why multiple drug resistant or MDR-TB is increasingly prevalent, accounting for an estimated 440,000 cases in 2008, of which a tiny fraction are treated in line with best practice. Patients take four or five pills a day, supplemented by a daily injection -- into alternate buttocks because it is so painful." The article also looks at the socio-economic and financial dimensions of drug-resistant TB (Jack, 3/23).
"In recent years, faster, more effective [TB] diagnostics technology has been developed. However, the challenge is to ensure it can be used in developing countries where healthcare infrastructure is weak or non-existent but where most of the world's TB patients live," the Financial Times reports in a story examining diagnosing TB in resource-limited settings. The article reports on several developments aimed at expediting the invention and use of newer, more efficient diagnostic techniques (Murray, 3/23).
Another Financial Times article looks at the South African government's plan to provide antiretroviral (ARV) drugs to "all TB/HIV co-infected patients." According to the newspaper, "Some 70 percent of people treated for TB in South Africa are also HIV-positive. The introduction of earlier-stage HIV treatment should help prevent those with latent TB from developing the full-blown disease" (O'Connor, 3/23). A second article about TB in South Africa reports on efforts by the health ministry toward "greater vigilance -- and resources -- to trace and treat every new case of [TB] infection." It also reports on efforts by other groups, such as the Anglo American mining group and the South African TB Vaccine Initiative, to control the disease (O'Connor, 3/23).
The series includes an article about TB control in China. The newspaper writes: "China provides a demonstration of just how hard it is to tackle tuberculosis in the developing world. The country has many of the prerequisites for constructing an effective strategy for treatment and prevention. It has a relatively well-organised health system and a long history of aggressive action against infectious disease. ... Yet despite all these efforts, it still faces an uphill struggle to control the disease" (Dyer, 3/23).
Another article reports on TB efforts in Brazil. "In its 2009 report on global TB control, Brazil ranks 14th on the World Health Organization's list of 22 countries that account for 80 percent of cases worldwide. The WHO estimates there were about 92,000 new cases in 2007 with an estimated incidence of 48 per 100,000 population." In addition, "TB is now the number one killer of people with HIV/AIDS in the country" (Wheatley, 3/23).
Media Outlets Examine TB in Countries Worldwide
Agence France-Presse writes, "India's government has said its free diagnosis and treatment programme, which monitors patients to make sure they take the right drugs in the right doses at the right time, has led to a marked cut in prevalence and mortality rates." But according to Zarir Udwadia, a doctor in Mumbai, the country's 110,000 patients with drug-resistant forms of the disease might be falling through the cracks. "The government fears that if drug-resistant TB takes hold it threatens to jeopardise the progress made in tackling the disease. As a result, it is widening its DOTS (directly observed treatment short-course) programme" (3/24).
The Daily Monitor examines drug-resistant TB in Uganda. "According to Dr. Grace Muzanye, a TB specialist with the Centre for Disease Control, although there are no precise figures on the numbers of drug-resistant TB, at least 10 percent of the 40,000 new cases recorded in 2008 were found to have strains that are resistant to drugs." The article reports on the lack of surveillance of drug-resistant TB in the country and the high cost of treating it (Lirri/Wandera, 3/24).
"Although Pakistan has made considerable achievements in the domain of TB control, evidence suggests that it still needs to expedite efforts to achieve better results. TB continues to be a major public health problem in the country, which ranks 8th among high-burden TB countries. With an estimated 300,000 new cases of TB every year, Pakistan contributes about 55 percent of the TB burden in the Eastern Mediterranean Region," the News International writes in a story focusing on TB control in Pakistan (Maqbool, 3/24).