Tuberculosis (TB)



24. The global, smear-positive case detection rate was 37% in 2002, over half way to the 70% target, and rising more quickly than at any time since 1995. Based on recent trends, we expect the case detection rate to be about 50% by 2005, by which time all TB patients reported in the public sector will receive the internationally recommended standard of care under DOTS. Smear-positive case detection by DOTS programmes could be increased from 37% to 50% simply by ensuring that the diagnosis and treatment of known TB cases in the Americas, Europe and South-East Asia conforms with DOTS standards. To get above 50% case detection will be challenging because the notification rate of all TB cases by public health authorities has been stable for many years, and because DOTS programmes will probably have exhausted this supply of cases by 2005. Beyond 2005, and preferably sooner, DOTS programmes and public health authorities must begin to recruit patients from non-participating clinics and hospitals, notably in the private sector in Asia, and from beyond the present limits of public health systems in Africa. A special effort must be made to improve cure rates in Africa.

25. To achieve these goals, governments and NTPs will need to take a more strategic approach to planning, match budgets more closely with plans, and match fundraising activities to realistic budgets. This is already happening in several HBCs, but not in all. If disbursements from the GFATM and other donors can be made more expeditiously, these funds will make a major contribution to TB control in several of the poorer HBCs whose governments cannot adequately support TB control. The HBCs planned to spend an extra US$ 150 million in total in 2003 (as compared with 2002), which is almost certainly too little to put them on the road to 70% case detection by 2005.