Drug resistance and HIV-AIDS threaten anti-TB drive

Expanding drug resistance and HIV/AIDS threaten to reverse tangible gains made in the global fight against tuberculosis, the World Health Organisation warned on 22 March.

The global tuberculosis epidemic is showing signs of slowing for the first time since the WHO declared it a global health emergency in 1993, the UN’s health agency said in a report on attempts to control TB.The overall number of cases continued to increase in line with the world’s population growth, reaching 8.79 million in 2005, against 8.71 million a year earlier.

Virtually no country in the world is spared, with cases reported in 199 nations, the report said. The overwhelming majority -- 7.4 million -- are found in Asia and sub Saharan Africa.However, the proportion of the population struck by the infectious respiratory disease stayed level and even declined in some regions, the report added.

“We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease’s ongoing burden," said UN Secretary General Ban Ki-moon.“Almost 60% of TB cases worldwide are now detected and, out of those, the vast majority are cured," he added. “But the disease still kills 4,400 people a day."

The progress identified in the report falls far short of meeting of a UN target of halving prevalence of the disease by 2015, health officials warned.

“There are serious challenges to the progress we have made. We need to redouble our efforts," WHO Director General Margaret Chan said.More than 2.1 million people were receiving multidrug treatment recommended by the WHO (DOTS), which is regarded as highly effective but requires steady medical follow-up and patient discipline.

The “DOTS" diagnosis and treatment programme was available in 187 countries by 2005, but access was uneven, the WHO said. Seven of the 22 countries worst affected by TB, including five African nations, had insufficient plans to expand health staff, according to the report.

“We need to tackle this problem as part of the larger challenge of increasing access to primary health care services," Chan said.“All people, no matter who they are or where they are, should have access to TB diagnosis and treatment as part of package of general health services that bring multiple health benefits," she added.

The “DOTS" package has formed the cornerstone of efforts to prevent drug resistance in recent years and has expanded. The report said treatment and cure targets were narrowly missed in 2005, except in 26 countries in the Pacific region and in south East Asia.The WHO also fears that “little effort" is being made to screen HIV patients for tuberculosis especially in Africa.HIV/AIDS patients with their weakened immune systems are highly susceptible to tuberculosis infections, and accounted for 195,000 of the 1.6 million TB deaths in 2005.

“In most cases tuberculosis is both curable and preventable, (yet) certainly in Africa is the first known cause of death of people living with HIV," Peter Piot, the head of UNAIDS, told journalists.

The report also underlined that the global scale of “extensively drug resistant" strains of tuberculosis (XDR-TB) discovered last year “is not yet known."

“It is really alarming because of the high mortality rate of people infected with these strains, which are resistant to all known anti-TB drugs. It is a serious threat to the global response," Piot said.

Health officials underlined that drug resistance thrived on inadequate investment and poor health services.“Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and medicines is more vital than ever," said Mauro Raviglione, head of the WHO’s anti-TB programme.

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