Only a fraction of TB patients get adequate care

A strategy that can cure up to 90 percent of all tuberculosis (TB) cases, and thus represents the best chance for controlling the global TB epidemic, is reaching only 27 percent of the world's TB patients, the World Health Organisation (WHO) reported on Friday.

The announcement was made by WHO in conjunction with the release of its latest annual report on TB, entitled "WHO Report 2002: Global Tuberculosis Control", and World TB Day on 24 March.

Public health officials had estimated that US $1 billion a year would be needed to treat patients and control the TB epidemic in 22 countries that now accounted for 80 percent of the world's TB cases, WHO stated. It also noted its surprise in finding that the governments of these 22 low-income nations were already paying 70 percent of the cost of TB treatment and control. "Clearly, even the poorest countries are deeply committed to fighting this disease, and the international community must respond just as vigorously," J.W. Lee, WHO's Director of Stop TB, said.

The strategy developed by WHO to fight TB, known as "DOTS" (directly observed treatment), has been cited as "one of the most cost-effective strategies ever devised against a major killer", according to WHO. DOTS has five key components: government commitment to sustained TB control; case detection by sputum microscopy; standardised treatment of six to eight months; regular supply of essential TB drugs; and a standardised reporting system.

It also requires that health workers watch TB patients take their drugs for at least the first two months of therapy, thereby reducing the chance of patients abandoning treatment before they are cured - which can lead to drug resistance developing in the patient, and that same resistance being passed on to others.

By the end of 2000, 148 of 210 countries were implementing the DOTS strategy, an increase of 21 countries since 1999, according to WHO. Where the DOTS approach was used in Asia, Africa and Latin America, it had produced an average cure rate of 80 percent, WHO added.

The goals set for TB control are that by 2005, 70 percent of all active infectious TB cases will be diagnosed and 85 percent will be successfully treated. "This requires a regular supply of drugs, equipped labs and trained health professionals," WHO stated. "While all of this is expensive, even the poorest countries are financing the bulk of TB costs themselves."

"Even so, this still leaves a gap of $300 million a year; about 30 cents a year for each person in the industrialised world," WHO added. "This shortfall has slowed the rate of expanding diagnosis and treatment services."

According to the new WHO report, at the current rate, TB targets set for 2005 will not be reached until 2013.

TB is a contagious disease that spreads through the air. Nearly one third of the world's population is infected with the TB bacillus, and 2 million people die of it each year. In 1993, the growing worldwide TB epidemic so alarmed public health experts that WHO declared TB a global emergency.

In Africa, TB is the major cause of death of people with HIV/AIDS.

WHO regularly assesses the state of the epidemic as well as progress being made against it. The current assessment is the sixth such report. For the complete report, go to: http://www.who.int