WHO Sees Surge in Progress Against Tuberculosis on Eve of Global Summit
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Geneva/New Delhi - The number of tuberculosis patients diagnosed
and treated under DOTS, the internationally recommended strategy
for TB control, is now rising much faster than at any time since
DOTS expansion began in 1995, according to a new report by the
World Health Organization (WHO). Indeed, the past two years have
witnessed accelerated growth in the implementation of DOTS pro-
grammes worldwide.
The 2004 Global Tuberculosis Control report confirms that DOTS
programmes are now treating three million TB patients every
year, an increase of more than one million patients compared to
just two years ago. That increase is nearly double the average
annual increment of 270 000 patients during the previous six-
year period, and the trajectory is still heading upward. India
is leading the surge with more than a quarter of all additional
DOTS cases being treated, followed by smaller but significant
increases in five other key countries with high rates of TB:
South Africa, Indonesia, Pakistan, Bangladesh and the Philip-
pines.
The findings of the report will be presented on Wednesday by LEE
Jong-wook, WHO Director-General, at the opening session of the
2nd Stop TB Partners' Forum in New Delhi, a two-yearly summit of
donors, technical agencies, NGOs and ministers from the 22 high-
TB burden countries under the umbrella of the global Stop TB
Partnership.
"DOTS expansion is one of the major public health success sto-
ries of the past decade, one that is saving thousands more lives
every day," Dr Lee said. "But to reach the 2005 targets for de-
tection and treatment, the challenge now is to add another one
million TB patients to DOTS programmes each year. Many of these
new cases will be recruited from the hospitals and private
health sector in Asia, especially China, and from beyond the
present limits of health systems in Africa."
The global 2005 targets for TB control are to detect 70% of all
infectious TB cases and cure 85% of those cases detected. Ac-
cording to the WHO report, the case detection rate has risen to
37% and cure rates to 82%. Meeting the 2005 targets will put the
world's TB control programmes on the path to achieving the Mil-
lennium Development Goal (MDG) of halving the global TB burden
by 2015.
Expanding and strengthening DOTS is key to halting the spread of
TB because it is cost-effective, ensures treatment compliance,
and prevents the development of drug-resistant strains of TB. Of
the 210 countries that reported TB case notifications and/or
treatment outcomes to WHO in 2002, 180 are today implementing
the DOTS strategy and providing access to services for nearly
70% of the world's population
The World Bank, a key member of the Stop TB Partnership and a
leading financier of TB-related programmes in developing coun-
tries, welcomed the WHO report as evidence that donor funding
for expanding DOTS treatment had proven effective in improving
the health and welfare of communities afflicted by the disease.
"This new evidence is important. Speeding up TB case detection
is the critical first step in curing more patients and driving
down disease," said James Wolfensohn, President of the World
Bank. "This gives us solid ground to push for the greater sup-
port needed to reach our goals faster. Strengthening overall
health systems to reach the poor will be another critical route
towards controlling TB."
There are an estimated 8.8 million new cases of TB each year of
which 3.9 million are infectious. The number of new cases is in-
creasing rapidly in Eastern Europe, mainly countries of the for-
mer Soviet Union which only recently started to implement DOTS.
A special surveillance report issued last week by WHO found that
TB patients in parts of Eastern Europe and Central Asia are 10
times more likely to have multidrug-resistant TB than in the
rest of the world. TB incidence rates also continue to rise at
an alarming rate in African countries with high HIV prevalence.
"HIV/AIDS is driving the TB epidemic in southern and eastern Af-
rica and will worsen the situation in Eastern Europe, India and
China in the years ahead," said Dr Jack Chow, the WHO Assistant
Director-General for HIV/AIDS, Tuberculosis and Malaria. "We
cannot control one without controlling the other, and must begin
rapidly scaling up TB/HIV collaborative activities to provide a
synergy of prevention, treatment and care for co-infected pa-
tients."
Another key document to be presented at the Delhi summit will be
a progress report on the Global Plan to Stop TB, the strategic
roadmap which guides the development and work of the Stop TB
Partnership. The report assesses progress in eight key areas:
DOTS expansion; DOTS-Plus for Multidrug-Resistant (MDR) TB;
TB/HIV, research and development for new TB drugs, diagnostics
and vaccines; the Global TB Drug Facility; and resource mobili-
zation. "The Global Plan covers the five-year period from 2001-
2005, and this progress report will tell us how well we are do-
ing in meeting the process targets of the Plan at the midway
point," said Ernest Lowensohn, chairman of the Stop TB Coordi-
nating Board.