Tuberculosis: The challenge posed by drug resistance
The WHO's Global Tuberculosis Report 2013 was released this week, highlighting the success in the policies to control tuberculosis, stating that the lives of 22 million people have been saved, while the number of patients being treated with the disease has fallen to 8.6 million, while deaths related to tuberculosis have decreased to 1.3 million.
This means that the 2015 Millennium Development Goal, to halve the number of deaths related to TB in relation to 1990, should be reached.
However, there are two major challenges underlined in this year's report, namely that of the missing cases - around three million people with TB not being picked up by healthcare systems and drug-resistant TB cases, given that the response to treat patients with MDR-TB (Multi-drug resistant TB) is inadequate.
Last year, according to the report, 450,000 people became ill with MDR-TB. Twenty-seven countries house the great majority of these cases, spear-headed by the PR China and India. In the same year, 94,000 new cases were discovered with rapid testing schemes but it is estimated that three out of four MDR-TB cases remain undetected. Cuts in funding mean that reduced numbers of healthcare officials are unable to meet the needs - in 2012, 16,000 MDR-TB cases were given no treatment and the lack of service capacity in many countries is translated into falling TB cure rates.
Furthermore, less than 60 per cent of patients living with TB and HIV were receiving antiretroviral drugs.
The reason behind these challenges, according to the World Health Organization, is mainly one - cash. The report claims that in both cases, lack of funds available to already stretched healthcare systems render them incapable of finding and treating patients outside the formal state healthcare system, often patients in "hard-to-reach" places. 75 per cent of the three million missed cases reside in 12 countries.
Mario Raviglione, Director of the Global TB Programme for the WHO, states: "Quality TB care for millions worldwide has driven down TB deaths but far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown."
Recommendations: The WHO's Five priority actions
The WHO report recommends five priority actions that could make a rapid difference between now and 2015.
- Reach the 3 million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and NGOs which serve large proportions of populations at risk.
- Address with urgency the MDR-TB crisis. Failure to test and treat all those ill with MDR-TB carries public health risks and grave consequences for those affected. High-level political commitment, ownership by all stakeholders, adequate financing and increased cooperation are needed to solve bottlenecks in drug supply and build capacity to deliver quality care.
- Intensify and build on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV.
- Increase domestic and international financing to close the resource gaps - now estimated at about US$ 2 billion per year - for an effective response to TB in low- and middle-income countries. Full replenishment of the Global Fund is essential, given that most low-income countries rely heavily on international donor funding, with the Global Fund providing around 75% of financial resources in these countries.
- Accelerate rapid uptake of new tools - through technology transfer and operational research to ensure that countries and communities most at risk benefit from these innovations.