Commemorating March 24 World TB Day
Despite recent progress, TB remains a major global public health problem, with nearly nine million new cases and more than 1.6 million deaths each year. With HIV/AIDS claiming over two million lives each year, and malaria killing more than one million, TB is one of the three leading causes of deaths worldwide due to infectious diseases.
Globally, an estimated ten percent of TB patients are also co-infected with HIV, and TB is the leading cause of death for AIDS patients. In parts of sub-Sahara Africa, rates of HIV co-infection among TB patients often exceed 50 percent.
TB is not just a public health challenge, but it is also a development problem as this debilitating disease strikes people during their most economically productive years.
TB not only takes an enormous personal toll, it also places a tremendous economic burden on families, communities, and countries. While TB treatment is often free, diagnosis, laboratory charges, transport, food and other costs can account for 8-20 percent of annual household income for TB patients, according to a study recently released by the World Bank.
Although a cure for TB has existed for more than half a century, the disease is often diagnosed late, treated improperly or not treated at all, leading to transmission in the community and death. Unfortunately, the most vulnerable people have the greatest difficulties in accessing good quality care. TB is both a disease of poverty - with transmission enhanced in over-crowded conditions - and a contributor to poverty. It takes a tremendous toll especially on poor families in developing countries.
The United States is on the frontlines of the battle against TB. In collaboration with host nation TB programs, the USG works to improve the quality of basic TB programs or DOTS (Directly Observed Therapy, Short Course) services; upgrade laboratory infrastructure; build a foundation to introduce new diagnostic technologies; and work with WHO and other partners to conduct drug resistance surveys and surveillance.
The U.S. Agency for International Development (USAID) is the lead USG agency in international TB control programs, supporting TB programs in 37 countries. Between 2000 and 2007, USAID provided nearly 600 million USD for TB programs worldwide. In FY 2007, USAID provided 5 million USD to the STOP TB Partnership's Global TB Drug Facility (GDF), an important mechanism that provides drugs to countries in need, and USAID funding to the GDF will increase to 15 million USD in FY08.
The USG also supports TB control worldwide through funding provided to the Global Fund to Fight AIDS, TB and Malaria (Global Fund), to which the USG is the largest single donor, with contributions exceeding 2.5 billion USD. Seventeen percent of support for the Global Fund has been dedicated to TB work.
Specifically with regard to multi-drug resistant tuberculosis (MDR TB), the USG is deeply concerned about the magnitude of the drug-resistance problem and we are committed to addressing it. In addition to our work to help countries strengthen their basic TB programs, the US has also been a global leader in addressing MDR TB. In the last year and a half, we have moved quickly to help countries and our international partners respond to the latest data on MDR. This has included support for drug-resistance surveys and the building of laboratory capacity to detect resistant strains, expanding country level programs to treat MDR TB patients, and support for the Green Light Committee (GLC), which helps ensure that countries have effective programs to manage MDR TB patients and second line anti-TB drugs.
Our efforts have particularly focused on countries that have the greatest burden of MDR TB, including Russia, South Africa, Namibia, the Baltic States, Ukraine, India, and Indonesia. Given the deadly combination of MDR/XDR TB and HIV, we have also focused attention on other parts of Africa, where laboratory capacity is particularly weak and there is very limited data on the scale of MDR TB.
Building strong human resource capacity and detailed strategic planning are crucial components of the response to MDR and XDR TB. USAID has supported regional training courses on MDR/XDR TB management in East and West Africa, India, South East Asia, and Latin America.
Like Norway, the United States is a global leader in its commitment to prevent and control the spread of this major global public health problem.