Tuberculosis Factsheet

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Millennium Development Goal 6: To combat HIV/AIDS, malaria and other diseases.

• Target 8: By 2015 to have halted and begun to reverse the incidence of malaria and other major diseases.

Key messages

• Tuberculosis (TB) kills approximately two million people each year and that number is going up all the time. In Eastern Europe and Africa, TB deaths are increasing after almost 40 years of decline. The breakdown in health services, the spread of HIV and AIDS and the emergence of multidrug-resistant TB are contributing to the worsening impact of this disease.
• The World Health Organization (WHO) declared tuberculosis a global emergency in 1993, so great was the concern about the modern TB epidemic.
• TB is a disease that disproportionately affects the poor, who are more vulnerable to infection and suffer more from the consequences of the disease.
• There is growing recognition that controlling TB has the potential to reduce poverty. The millennium development goals link achievement of health outcomes – with TB control as an indicator for progress – to the elimination of poverty.

Facts and figures

• Every 15 seconds someone dies of TB. But almost everyone could have and should have been cured. The best way to prevent TB is to treat and cure the people who have it.
• More than eight million people become sick with TB each year. Each one can infect between 10 and 15 people in one year just by breathing.
• Globally, around three million TB cases per year occur in south-east Asia and around two million TB cases per year occur in sub-Saharan Africa. The latter is rising rapidly as a result of the HIV and AIDS epidemic. Over a quarter of a million TB cases per year occur in Eastern Europe.
• IF TB controls aren’t strengthened, an estimated one billion people will be newly infected with TB between 2002 and 2020, over 150 million people will get sick, and 36 million will die.
• HIV and TB form a deadly combination, each increasing the other’s impact. In Africa, HIV is the most important factor behind dramatically increased incidence of TB in the last 10 years.
• Almost 30 per cent of people with HIV are also infected with TB. TB is the most common opportunistic infection among people with HIV and is a leading cause of death among people who are HIV positive.
• TB is a disease of poverty. Ninety-two percent of cases and deaths occur in low income and lower middle-income countries.
• The globally agreed target for TB is: By 2005, 70 per cent of people with infectious TB will be diagnosed, and 85 per cent cured.

Are we on track to meet the MDG?

The World Health Organisation has set TB-control goals for 2005. These goals are to detect 70 per cent of new infectious (smear positive) cases worldwide and to successfully treat 85 per cent of all cases detected. Much progress has been made towards the targets but more remains to be done if we are going to achieve these goals. There is a better chance of meeting the treatment success target than the case detection target.

• Treatment success for directly observed treatment (DOTS) worldwide is 82 per cent on average, just below the 85 per cent goal for 2005. (See case studies for more information on DOTS)
• In 2002 an estimated 37 per cent of new smear positive cases were notified under DOTS programmes, an increase from 27 per cent in 2001 and halfway towards the 2005 target. Progress is accelerating – especially in some of the high burden countries such as India. However, even with these encouraging recent trends, we expect the case detection rate to be only 50 per cent by 2005 – missing the target.

Obstacles to improvement

• TB is spreading faster than TB-control efforts, and urgent action is required to mobilise sufficient resources, public awareness and political commitment to halt it.
• Particularly worrying is the emergence of HIV-associated TB and multi-drug resistant TB.
• The broad approach adopted by current TB control efforts does not automatically result in benefits for the poor people most at risk from contracting it. More needs to be done to target services to control TB at the poor people most affected.

Progress - What DFID is doing to help

Supporting global partnerships

• DFID supports the global Stop TB Partnership, providing £2 million since 2002.
• DFID has been a key donor to the Global Fund to Fight AIDS, TB and Malaria (created in 2002), pledging US$280 million in May 2004, and a further pledge in July 2004 of £154 million over the next three years, effectively doubling the existing pledge for 2005-2007. The Global Fund has already approved grants totalling US$2.1 billion for direct support to programmes in developing countries. Early results include the training of private practitioners in the DOTS treatment strategy for tuberculosis in Philippines.
• DFID provides core funding to the WHO, which recommends Directly Observed Treatment Short Course (DOTS) for the detection and cure of TB (see case studies).
• The UK’s Call for Action on HIV/AIDS (2003) set out our plans to maximise the synergy between efforts to tackle TB and HIV.

Strengthening health systems

DFID places a high priority on ensuring that TB services are accessible through well functioning health systems. Since 1997, DFID has committed over £1.5 billion to strengthening health systems at country level so that better care and drugs can be delivered.

Development of new research evidence

DFID supports TB knowledge programmes at the London and Liverpool Schools of Tropical Medicine. We also give significant research contributions to the Medical Research Council and WHO.

DFID research programmes on TB include:

• Support for WHO to carry out cost-effectiveness studies of TB Control in the Russian Federation; and
• Support to the London School of Hygiene & Tropical Medicine to research prophylaxis for prevention of TB in persons with HIV infection in Zambia and Kenya.

Providing cheaper anti-TB treatment

DFID is working with others, including G8 colleagues, to secure greater international commitment to affordable pricing for medicine, including drugs to treat TB. DFID recognises the important role played by the Global TB Drug Facility to support global efforts to increase the availability, affordability and quality of TB treatment.

Case studies

DFID-funded programmes to improve TB detection and cure rates

DFID is supporting a number of countries in their fight to slow down and reverse the spread of TB. This help is often given as part of health sector plans, or budget support. Examples of DFID funding include:

• £4.5million in Malawi (1999 – 2004) to improve on an equitable basis the case detection, quality of diagnosis and outcome of TB treatment;
• In China, DFID has committed £28 million over 7 years in partnership with the World Bank towards an effective and sustainable National TB control programme focused on the poor;
• £5.4m in Nepal to provide effective diagnosis and treatment for all patients with TB within the existing primary health care services;
• £20 million in India to make sure quality TB services are available to poor people and particularly women in Andhra Pradesh.
• £1.9m in Russia (2000 – 2005) to assist the authorities in Kemerovo and Samara to develop a cost-effective, multi-sectoral TB control programme.

Directly Observed Treatment Short Course (DOTS)

DOTS combines:

• appropriate diagnosis of TB and registration of each patient detected, followed by standardized multi-drug treatment;
• a secure supply of high quality anti-TB drugs for all patients in treatment;
• individual patient outcome evaluation to ensure cure;
• cohort evaluation to monitor overall programme performance.

Since DOTS was introduced on a global scale in 1991, about 10 million patients have received DOTS treatment. By the end of 2000, all 22 of the highest burden countries, which are home to 80 per cent of the world's estimated incident cases, had adopted DOTS. Twenty-seven percent of estimated TB patients received treatment under DOTS, two and a half times the number reported in 1995. In the half of China where DOTS has been introduced, cure rates among new cases are 96 per cent. In Peru, widespread use of DOTS for more than five years has led to the successful treatment of 91 per cent of cases and a decline in incidence.