The number of tuberculosis patients diagnosed and treated under DOTS, the internationally recommended strategy for TB control, is now rising much faster than at any time since DOTS expansion began in 1995, according to a new report by the World Health Organization (WHO). Indeed, the past two years have witnessed accelerated growth in the implementation of DOTS programmes worldwide.
The 2004 Global Tuberculosis Control report confirms that DOTS programmes are now treating three million TB patients every year, an increase of more than one million patients compared to just two years ago. That increase is nearly double the average annual increment of 270,000 patients during the previous six-year period, and the trajectory is still heading upward. India is leading the surge with more than a quarter of all additional DOTS cases being treated, followed by smaller but significant increases in five other key countries with high rates of TB: South Africa, Indonesia, Pakistan, Bangladesh and the Philippines.
The findings of the report will be presented Wednesday by LEE Jong-wook, WHO Director-General, at the opening session of the 2nd Stop TB Partners' Forum in New Delhi, a two-yearly summit of donors, technical agencies, NGOs and ministers from the 22 high-TB burden countries under the umbrella of the global Stop TB Partnership.
"DOTS expansion is one of the major public health success stories of the past decade, one that is saving thousands more lives every day," Dr Lee said. "But to reach the 2005 targets for detection and treatment, the challenge now is to add another one million TB patients to DOTS programmes each year. Many of these new cases will be recruited from the hospitals and private health sector in Asia, especially China, and from beyond the present limits of health systems in Africa."
The global 2005 targets for TB control are to detect 70% of all infectious TB cases and cure 85% of those cases detected. According to the WHO report, the case detection rate has risen to 37% and cure rates to 82%. Meeting the 2005 targets will put the world's TB control programmes on the path to achieving the Millennium Development Goal (MDG) of halving the global TB burden by 2015.
Expanding and strengthening DOTS is key to halting the spread of TB because it is cost-effective, ensures treatment compliance, and prevents the development of drug-resistant strains of TB. Of the 210 countries that reported TB case notifications and/or treatment outcomes to WHO in 2002, 180 are today implementing the DOTS strategy and providing access to services for nearly 70% of the world's population.
The World Bank, a key member of the Stop TB Partnership and a leading financier of TB-related programmes in developing countries, welcomed the WHO report as evidence that donor funding for expanding DOTS treatment had proven effective in improving the health and welfare of communities afflicted by the disease. "This new evidence is important. Speeding up TB case detection is the critical first step in curing more patients and driving down disease," said James Wolfensohn, President of the World Bank. "This gives us solid ground to push for the greater support needed to reach our goals faster. Strengthening overall health systems to reach the poor will be another critical route towards controlling TB."
There are an estimated 8.8 million new cases of TB each year of which 3.9 million are infectious. The number of new cases is increasing rapidly in Eastern Europe, mainly countries of the former Soviet Union which only recently started to implement DOTS. A special surveillance report issued last week by WHO found that TB patients in parts of Eastern Europe and Central Asia are 10 times more likely to have multidrug-resistant TB than in the rest of the world. TB incidence rates also continue to rise at an alarming rate in African countries with high HIV prevalence.
"HIV/AIDS is driving the TB epidemic in southern and eastern Africa and will worsen the situation in Eastern Europe, India and China in the years ahead," said Dr Jack Chow, the WHO Assistant Director-General for HIV/AIDS, Tuberculosis and Malaria. "We cannot control one without controlling the other, and must begin rapidly scaling up TB/HIV collaborative activities to provide a synergy of prevention, treatment and care for co-infected patients."