Tuberculosis (TB)

Key points

TB epidemic

  • There were 9 million new TB cases and approximately 2 million TB deaths in 2004.
  • The number of TB cases was stable or falling in 5 of 6 WHO regions, but growing in Africa where the TB epidemic is still driven by the spread of HIV.
  • More than 80% of all TB patients live in sub-Saharan Africa and Asia.

DOTS and the new Stop TB Strategy

  • DOTS, which remains at the heart of the new Stop TB Strategy, was being applied in 183 countries in 2004; population coverage was complete in 9 of 22 high-burden countries (HBCs), and almost complete in 5 others.
  • Expanding areas of work within the new strategy include: community and NGO participation in TB care; advocacy, communication and social mobilization; and improved management of multidrug-resistant TB and TB/HIV.
  • Six Asian countries and Kenya have already improved links between national TB control programmes (NTPs), hospitals and other health-care providers, but PPM-DOTS is still at an early stage in most other HBCs.
  • Areas of particular weakness are laboratory services, human resource development and the monitoring of TB/HIV control.

Finances

  • The total cost of TB control in 2006, including NTP budgets and costs to the general health-care system, has grown to US$ 1.6 billion in the 22 HBCs. This increases to US$ 2.0 billion for all 74 countries that provided financial data.
  • Funding to support TB control in the 22 HBCs has increased by almost US$ 500 million since 2002, reaching US$ 1.4 billion in 2006.
  • Governments of the wealthier HBCs (notably Brazil, China, the Russian Federation and South Africa) provide most of the funding needed for TB control in their countries; other countries rely more on grants from donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria.
  • The funding gap reported by the 22 HBCs for 2006 was US$ 141 million; it was US$ 180 million in total for the 74 countries that reported data.
  • NTP budgets for 2006 are broadly in line with the Global Plan to Stop TB, 2006–2015, except for TB/HIV control where NTP budgets are much lower.

Targets

  • Case detection was 53% globally in 2004, and is likely to exceed 60% in 2005, falling short of the 70% target.
  • Treatment success was 82% in the 2003 cohort of 1.7 million patients, approaching the 85% target.
  • Three WHO regions are expected to meet both of the 2005 targets: the Region of the Americas and the South-East Asia and Western Pacific regions.
  • At least 7 HBCs should have met the 2005 targets: Cambodia, China, India, Indonesia, Myanmar, the Philippines and Viet Nam.
  • Implementation of the Global Plan is expected to reverse the rise in incidence globally by 2015, as specified by the Millennium Development Goals, and to halve 1990 prevalence and death rates globally and in most regions by 2015, though not in Africa and eastern Europe.
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