April 23, 2001
Evidence being presented this week at the Organization of African Unity Summit on HIV/AIDS, TB and Other Infectious Diseases in Abuja, Nigeria, will show that TB cases are increasing 10% per year in Africa because of HIV. There were nearly two million new TB cases in Africa in 1999, with two-thirds of those also infected with HIV. Experts estimate that the number of TB cases in Africa will reach 3.3 million by 2005 and surpass 4 million shortly thereafter.
"There is an urgent need to address TB and HIV together," said Dr Peter Piot, Executive Director of UNAIDS, "Reducing transmission of HIV will reduce the epidemic of TB. Joint TB/HIV activities are needed to decrease the burden of HIV-related TB."
"Tuberculosis is a leading killer of people living with HIV/AIDS," said Dr Gro Harlem Brundtland, Director-General of WHO. "Up to 50% of people with HIV in sub-Saharan Africa develop TB. This is one of the reasons why the control of TB and HIV in Africa is so interdependent."
Another reason is that people with HIV -- just like people who are sick with TB -- can easily develop drug-resistant forms of these infections unless their medications are provided under some form of supervision.
Care and support for TB patients is provided through a strategy known as DOTS (the internationally recommended TB control strategy). This strategy -- first developed in Tanzania in the 1980s -- makes maximum use of community health workers and volunteers to provide support to patients and to ensure that they are taking their medication until they are fully cured. Increasing the availability of DOTS in Africa is considered a key not only for curing TB cases but also for organizing health infrastructure in communities for the future provision of anti-retroviral drugs required for treating HIV.
"Experience in increasing access to TB drugs will make an enormous contribution to HIV/AIDS care and support," said Dr Jong-Wook Lee, Director of Stop TB Department in WHO. "The DOTS strategy provides an excellent model for increasing access to anti-retrovirals."
A key principle of DOTS is the use of effective standardized treatment regimens, provided in a supportive and patient-friendly environment, with direct observation of treatment to maximize adherence and reduce drug resistance.
Currently, over 300 000 people in Africa are being treated for tuberculosis using the DOTS strategy.
Worldwide, nearly 900 000 people are treated through DOTS services. Their cure rates are two to three times higher compared to patients without access to the DTOS strategy. Drug resistance is three times lower in DOTS projects than in health services not providing DOTS.
WHO and UNAIDS recommend rapid expansion of DOTS services. There is a need to strengthen national and local infrastructures and community-based care approaches to tackle TB and HIV.
The strong increase in TB cases that have occurred in many sub-Saharan African countries has often outstripped their capacity to maintain adequate supplies of TB drugs. The Stop TB global partnership, hosted by WHO, recently launched the Global TB Drug Facility, a new initiative to rapidly expand DOTS by increasing access to high quality TB drugs.
TB germs are transmitted through the air, spreading from person to person through coughing, sneezing or even talking. As the disease progresses, it is characterized by fever, weight loss and violent coughing which effectively disperses the TB germs to infect surrounding individuals. Nearly 2 billion people -- one-third of the world's population -- are currently infected with the TB germ. Between 5% to 10% of these people will eventually become sick with TB.
However, people infected with both the TB germ and HIV are 30 times more likely to become sick with TB than people infected with the TB germ only.