Progress In Global Fight To Stop TB Slowing, WHO Report Says

Main Category: Tuberculosis
Also Included In: HIV / AIDS
Article Date: 20 Mar 2008 - 6:00 PDT

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The pace of progress in detecting new tuberculosis cases worldwide is slowing, according to the 12th annual report on TB control released Monday by the World Health Organization, the New York Times reports. According to the report -- titled "Global Tuberculosis Control 2008 -- Surveillance, Planning, Financing"-- the rate of increase in detecting new TB cases was 3% from 2005 to 2006, compared with the previous average of 6% recorded from 2001 to 2005 (Altman, New York Times, 3/18).. The report found that out of the total 14.4 million people living with TB in 2006, the last year for which statistics are available, 9.2 million were new cases. Global deaths from the disease decreased by 2.6% in 2006 to 1.7 million people when compared with 2005 figures, the report found (Dunham, Reuters, 3/17). TB incidence worldwide decreased by 0.6% in 2006, but the decrease was so modest compared with 2005 that the increase in the world's population meant there were actually more TB cases, the report noted (Reuters, 3/17). Health officials said that they ideally want to see TB incidence decline by 5% to 7% annually (Cheng, AP/Google.com, 3/17).

About 700,000 of the TB cases and 200,000 deaths occurred among people who are HIV-positive, WHO reported. WHO's Africa, Southeast Asia and Western Pacific regions accounted for 83% of the total cases reported. The African region has 363 cases per 100,000 people, which is the world's highest incidence rate per capita, the report said. It found that China, India, Indonesia, Nigeria and South Africa topped the list in terms of absolute numbers of TB cases. The information is based on data provided by 202 countries and territories (New York Times, 3/18). WHO estimated that 61% of all TB cases worldwide are registered (AFP/Google.com, 3/17).

About 30 million people, or 84.7% of reported TB cases, have successfully completed treatment, according to the report. That figure is close to WHO's target of 85%. However, the report found that WHO's treatment programs have "not yet had a major impact on TB transmission and incidence around the world." In addition, the report found that TB rates had fallen in some regions, stabilized in Europe and increased at least fivefold in Africa since the 1990s (AP/Google.com, 3/17).

The report identified multi-drug resistant TB and HIV/TB coinfection as two factors that could further slow progress toward controlling TB, according to a WHO release. Countries predict they will treat only about 10% of people with MDR-TB in 2008 because of limited laboratory and treatment capacities, according to the report. Funding also is a concern, the report said. Despite increases in resources from the Global Fund To Fight AIDS, Tuberculosis and Malaria and some middle-income countries, TB budgets likely will not increase in 2008 in nearly all of the countries most heavily burdened by the disease, the report said. Ninety countries in which 91% of the world's TB cases are recorded provided complete financial data for the report. These 90 countries need about $1 billion to meet the 2008 targets of the Global Plan to Stop TB, 2006-2015, the report said (WHO release, 3/17). In addition, WHO said that there is a funding shortfall of $2.5 billion of the $4.8 billion needed in 2008 for overall TB control in low- and middle-income countries (New York Times, 3/18).

Reaction
Margaret Chan, WHO director-general, said the slowing progress documented in the report "comes at a time when numbers are still way too high" (AFP/Google.com, 3/17). Mario Raviglione, director of WHO's Stop TB Department, said, "We're really in a very uncertain situation, so I don't feel happy at all, actually, that it is really getting controlled" (Reuters, 3/17). He added that data are worrisome because the "more cases that are detected early interrupt transmission and provide a better chance of cure, and that ultimately has a greater impact on the incidence of the disease (New York Times, 3/18).

Joanne Carter of RESULTS said the data should "serve as a warning to the global community that we must do more and be more aggressive in supporting TB programs or face a continued erosion of progress." She added that "on top of last month's data on high rates of drug resistance, we should take this very seriously and act with urgency" (Reuters, 3/17).

The report "clearly demonstrates how closely TB and HIV are" related, UNAIDS Executive Director Peter Piot said, adding that TB is the "single most important cause of death for people living with HIV" (AFP/Google.com, 3/17).

Some experts criticized WHO for not taking into account people living with TB who have not been diagnosed, the AP/Google.com reports. Critics also said the statistics were gathered from governments without being verified independently. "This is a compilation of what the countries want to show ... Some of these data are too good to be true," Francis Varaine, coordinator of Medecins Sans Frontieres' Tuberculosis Working Group, said (AP/Google.com, 3/17).

Raviglione said that countries should either create facilities to detect more cases or "depend more and more on the private sector" because "more and more we are realizing that nongovernmental agencies and faith-based organizations that contribute to caring for AIDS cases now have an increased role" in TB (New York Times, 3/18).

The report is available online.

Updated TB information from the 2008 WHO report is now available at the Kaiser Family Foundation's GlobalHealthReporting.org and GlobalHealthFacts.org.

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