Expert panel says world TB crisis is far from over

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“Taking medication is not easy.  The pills taste bad and they make my stomach upset.  After I take them, I don’t like anyone to talk to me.  It takes a while before I feel better.  I know it is my obligation and responsibility, but how much longer must I take them?”

Those are the words of a nine-year-old multidrug-resistant tuberculosis (MDR-TB) patient who passed away shortly thereafter, becoming one of 250,000 children around the world who die of TB every year.  They were relayed by Rachel Orduño, a TB patient advocate with The TB Photovoice Project, at a briefing entitled “Accelerating Progress to Combat TB: Innovation and Partnership,” sponsored by the office of Rep. Eliot Engel (D-NY) and several organizations including the Global Health Council, Cepheid, and the TB Alliance.  Held in recognition of World TB Day, the panel featured TB experts and African ministers of health discussing the burden of TB globally and in the U.S.

Orduño also relayed her own experiences as a TB patient in Texas.  She was diagnosed with diabetes in 2003, and started showing active TB symptoms within the year.  However she was not diagnosed with TB until 2006, after being misdiagnosed for three years with everything from allergies, to sinusitis, to pneumonia, and asthma.  Within those three years she transmitted the disease to six family members, including her youngest niece.  She likened taking TB medicine to torture for her niece, who had great difficulty taking the medications and would often vomit afterward. 

Orduño joined with other panelists in urging U.S. lawmakers to scale up efforts to combat this global epidemic, which claims the lives of 1.7 million each year, despite being a curable disease.  Event moderator Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership, said that although TB causes more deaths than any other disease, it lags behind other diseases when it comes to resource distribution and publicity.  The Stop TB Global Plan aims to diagnose and treat 32 million people with TB by 2015, and test 30 million TB patients for HIV while screening 71 million people living with HIV for TB.  Ditiu warned that if more resources aren’t dedicated to fighting this epidemic, 8 million people will die over the next five years, while 2 million new cases of MDR-TB will emerge. 

Kenneth Castro, director of the Division of TB Elimination in the National Center for HIV, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC), cautioned that although the latest figures show that TB rates are at their lowest ever in the U.S., a premature declaration of victory must be avoided and efforts to fight TB worldwide renewed, as no one can be protected from this global disease.  Not only does the U.S. have a moral imperative to fight TB globally, Castro said, but it is in America’s best interests to do so.  Investing in better diagnostics, drugs, and vaccines in the global fight will ensure that TB won’t spread to the U.S. 

Mphu Ramatlapeng, minister of health in Lesotho, explained that working with U.S. partners in the small country’s fight against HIV and TB has strengthened the entire region.  Thanks to American taxpayers, thousands of lives have been saved, she said.  Lesotho, with a population of 1.3 million, has an HIV prevalence rate of 23 percent.  Ramatlapeng explained that if it weren’t for the Global Fund to Fight AIDS, TB and Malaria; the President’s Emergency Plan for AIDS Relief; the CDC; and university partners like Columbia and Harvard, Lesotho would have no programs to speak of.  Lesotho is using funding effectively, and working hard to utilize all resources while devoting more government funds to the health sector, particularly for HIV and TB, she said.  Ramatlapeng made an appeal to lawmakers to devote more funds to the Global Fund in particular, which has had a profound impact on Lesotho’s fight against HIV and TB.

Benedict Xaba, minister of health in Swaziland, also expressed gratitude to American taxpayers for their support in making great strides and progress against HIV and TB in his country, which has a population of 1 million and an HIV prevalence of 26 percent. Sixty thousand people are currently enrolled in antiretroviral treatment (ART) programs, and 155,000 were tested for HIV last year.  TB is a huge problem in Swaziland, Xaba said.  With an incidence rate of 1,257 cases per 100,000 people, Swaziland’s TB incidence is 300 times higher than that of the U.S.  On top of that, 10 percent of all new TB cases are cases of MDR-TB.  Seen as one of the causes of a declining population, TB has been declared a national emergency, and 84 percent of people living with TB are co-infected with HIV.  The co-infection epidemic has put a huge strain on the healthcare workforce.  Although Swaziland is facing a financial crisis and budgets have been cut from all sectors, the health budget has been untouched. Xaba echoed Ramatlapeng stating that support from the Global Fund and other U.S.-supported donors have made a huge difference in Swaziland’s ability to tackle HIV and TB. 

Ditiu ended the discussion by sharing images from the TB crisis in Eastern Europe while emphasizing that we must do more.  She shared a photo of a young woman suffering from MDR-TB with her toddler. The woman passed away shortly after the photo was taken, and Ditiu did not know what happened to the child.  The panelists stressed that images like these are becoming all too common and will continue to unless more action is taken to stop the global TB epidemic.

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