 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
 |
|
||||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
 |
 |
|
|||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
 |
|
||||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|||||||||||||||||
 |
 |
 |
 |
 |
|
|||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
|
||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
 |
|
||||||||||||||||||||||||||||||
 |
 |
|
||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
|
|||||||||||||||||||||||||||
 |
|
|
|
 |
|
||
 |
 |
|
|
 |
|
||
 |
|
||
 |
|
||
 |
 |
|
|
 |
|
||
 |
 |
|
|
 |
|
||
TuberculosisTB kills 1.7 million people every year. Of these, almost half a million people are co-infected with HIV. One in three of the global population -- about 2 billion people -- have latent TB infection, but only about 10% of them will go on to develop the disease.
TB is spread by infectious droplets -- through coughing, sneezing, or spitting. It thrives in conditions of poverty and overcrowding. A person with active TB can infect an average of 15 people a year.
Every year there are about 8 million new TB cases and the poorest and most vulnerable are at highest risk. The disease strikes people during their most productive years. Three out of four deaths occur between the ages of 15 and 54.
DOTS
Millions of TB deaths could be prevented through the widespread use of DOTS, an inexpensive strategy for the detection and treatment of TB. The strategy can detect and cure TB even in the poorest countries. In 1997, the average treatment success rate worldwide was almost 80%. However, less than 25% of people who are sick with TB are treated through the DOTS strategy.
DOTS is a 5-pronged strategy for TB control involvin
- government commitment to sustained TB control
- detection of TB cases through sputum smear microscopy among symptomatic people
- regular and uninterrupted supply of high-quality TB drugs
- 6-8 months of regularly supervised treatment (including direct observation of drug-taking for at least the first two months)
- reporting systems to monitor treatment progress and programme performance.
While DOTS has been shown to be successful in many different settings worldwide, the effectiveness of this strategy is facing two new challenges: the spread of multidrug-resistant TB (MDR-TB) and the co-epidemic of TB/HIV. To address these challenges, WHO and its partners have established two initiatives: DOTS-Plus for MDR-TB and proTest for TB/HIV.
DOTS-Plus is a pilot strategy to address multidrug-resistant tuberculosis (MDR-TB), defined as resistant to at least isoniazid and rifampicin, the two most powerful TB drugs. DOTS-Plus includes the five elements of the DOTS strategy and in addition takes into account specific issues that need to be addressed in areas where there is a relatively high prevalence of MDR-TB. The aim is to assess the feasibility and cost-effectiveness of treating MDR-TB with these second-line drugs in resource-limited settings.
proTest, a new initiative in sub-Saharan Africa, is promoting voluntary counselling and testing for HIV as an entry point for a range of HIV and TB prevention and care interventions. Two-thirds of the people living with HIV worldwide are in sub-Saharan Africa and over 90% do not know they are infected. The region accounts for 70% of all co-infections with TB/HIV .