TB programming, research slowed by inadequate funding

The number of people dying from tuberculosis fell to its lowest level in a decade in 2010, but experts warn that a shortfall of US$1 billion for TB programmes in 2012, and the recent cancellation of funding by the Global Fund to fight AIDS, TB and Malaria, threaten these gains.

According to the UN World Health Organization's (WHO) 2011 Global Tuberculosis Control Report, the number of people with TB dropped to 8.8 million in 2010, from a peak of nine million in 2005, while deaths fell to 1.4 million in 2010 from 1.8 million in 2003.

TB is a leading cause of death for people living with HIV in Africa; WHO reports that 44 percent of TB patients in Africa tested for HIV in 2010 were positive.

WHO reports that funding from domestic and donor sources is expected to amount to $4.4 billion in 2012, up from $3.5 billion in 2006; however, countries are reporting funding gaps of close to $1 billion in 2012.

"Continued gaps in funding mean that many people with TB will continue to be undiagnosed, or diagnosed but treated with sub-standard care. This allows transmission of TB in the community to continue," said Katherine Floyd, coordinator of TB monitoring and evaluation for WHO's Stop TB Department. "Global targets set for 2015 - to halve cases and deaths compared to 1990 levels - will not be achieved without increased funding in the next four years."

Floyd noted that the cancellation of Round 11 funding by the Global Fund - which provides about $500 million for TB programmes globally each year - could have severe repercussions.

"In many countries, Global Fund investments represent 50 percent or more of the total funding that is available. Cancellation of Round 11 means that some countries will lose the opportunity to apply for a new stream of funding," she added. "More positively, much of the funding from the Global Fund in the next three to four years was already committed in earlier rounds - for HIV, TB and malaria combined there is around $10 billion to disburse from previous rounds in 2012 and 2013.

"What is really critical is that the available funding from previous rounds is used for high-impact, cost-effective interventions."

While all other regions are on track to achieve a 50 percent decline in mortality by 2015, Africa is unlikely to achieve this target; officials say poor funding is the main stumbling problem.

Strengthening diagnostics

The report highlights the need to strengthen diagnostics; of the 36 countries on the list of 22 high-burden TB countries and 27 high multi-drug resistant TB (MDR-TB) burden countries, 20 have less than the benchmark of one laboratory capable of performing culture and drug susceptibility testing per five million people.

Kenya is one of the better-funded programmes on the continent, with both the government and international partners – including the US government - contributing large amounts to diagnosis and treatment of TB. However, Joseph Sitienei, head of Kenya's National TB and Leprosy Control Programme, told IRIN/PlusNews the country faced a $16 million gap to finance its activities in the coming year.

"At the moment, we have 1,300 diagnostic sites for TB nationally, but in order to effectively tackle the disease, we need many more; we need at least 12 labs that are able to do TB culture, but nationally we have only one. With more money, we would also be able to better identify and treat people with drug-resistant strains of TB.

"There is no shortcut; the government must allocate the resources," he said.

Kenya is treating some 290 out of 320 identified cases of MDR-TB at a cost of over $22,000 per patient, compared with about $78 for a course of first-line drugs. It is estimated the country has more than 2,000 cases of MDR-TB.

Sitienei noted that more funds for TB would also allow the government to focus on treatment, paediatric TB and mitigating the impact of HIV in TB patients.

Research funding

According to Floyd, gaps in funding for TB research and development (R&D) are another concern. "Funding for R&D... actually fell between 2009 and 2010. Current funding is only one-third of the $1.8 billion per year that is estimated to be needed in the Stop TB Partnership's Global Plan to Stop TB 2011-2015," she said.

A recent report by the policy think-tank, Treatment Action Group, found that 71 donors invested $617.1 million in TB R&D in 2010 — a 0.3 percent decline from 2009 levels, but a 73 percent increase since 2005.

WHO's report notes there are several promising new drugs in the pipeline and nine vaccine candidates for the prevention of TB in Phase I or Phase II. However, according to a 2011 study published in the Journal of Infectious Diseases, the limitations of existing TB diagnostic tools are significantly hampering tuberculosis control efforts, particularly in areas with high HIV prevalence and drug-resistant TB.

"If the fight against TB [were] fully funded in the next four years in line with the Stop TB Partnership's Global Plan to Stop TB 2011-2015, then TB mortality would be cut in half by 2015 compared with its level in 1990; the number of cases would be falling globally and in all major regions," said Floyd.

"About 30 million people with TB would have been successfully treated between 2011 and 2015 and there would be much better diagnosis and treatment of MDR-TB and much better treatment for TB patients co-infected with HIV."

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