This week the World Health Organization (WHO) released updated data to compliment their 2009 Global Tuberculosis Control Report released on World TB Day. The earlier report released in March contained dramatic new data showing rates of TB-HIV co-infection twice as high as originally estimated.
This interim report is designed to fill an 18-month gap between the full reports of 2009 (in March) and 2010 (in October), following changes to the production cycle of the report in 2009 that have been made to ensure that future reports in the series contain more up-to-date data.
The update shows cautious progress in addressing the lethal combination of TB and HIV, reflecting efforts to better integrate the response to both diseases. Between 2007 and 2008, 1.4 million TB patients were tested for HIV, an increase of 200,000. Of those who tested HIV positive, one-third benefited from life-saving HIV anti-retroviral therapy (ART) and two-thirds were enrolled on co-trimoxazole prophylaxis to prevent the risk of fatal bacterial infections. Screening for tuberculosis and access to isoniazid preventive therapy for TB among people living with HIV also more than doubled over this time.
However, although progress has been made, these numbers still only reach about 1/3 of the milestones set for 2009 in the Global Plan to Stop TB (2006-2015), and it is clear that there is still much to be done. Millions of patients continue to be let down because they are unable to access high-quality care. In 2008, 1.8 million people died from TB including half a million deaths associated with HIV – many of them because they were not enrolled on ART.
The updated data reports that between 2007-2008, the highest ever number of infectious patients – 2.3 million people – were cured. With 87% of treated patients being cured, the 85% global target was exceeded for the first time since it was established in 1991. Despite these seemingly impressive statistics, WHO report that too many cases continue to going undiagnosed and therefore untreated. The detection of new smear-positive TB cases has slowed, suggesting that the 2010 milestone of a 78% detection rate will not be achieved unless TB programmes actively engage communities to find cases amongst the most vulnerable members of society.
Of great concern is the fact that the majority of people with multidrug-resistant TB (MDR-TB) are still not being diagnosed or receiving effective treatment. Of the estimated half a million MDR-TB cases occurring per year, almost 30,000 were officially reported and only 6,000 were known to be treated according to WHO international standards in 2008. Although a major expansion of services is currently underway, considerable investment will be required to reach the 29,000 people WHO expects to be treated in 2010.
In his end of year statement, Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership, reiterated that funding remains the most serious challenge. From 2006-2008, the financing needs for funding TB control worldwide was short by $US 1 billion per year. The gap for research and development was approximately US$ 0.5 billion for 2007.
With TB remaining second only to HIV/AIDS in terms of the number of people it kills, and with the disease killing half a million women alone last year, it is crucial that the funding gap for TB care and control in 2010 is filled so that lives do not continue to be needlessly lost.