The latest report from the United States Agency for International Development on the U.S. role in the global tuberculosis response shows that while government agencies have made important contributions to the global TB effort, significant challenges continue to stand between universal access to prevention, care and treatment, and the impoverished populations that need those interventions the most.
Tuberculosis took 1.4 million lives in 2011, including half a million women and an estimated 60,000 children, while infecting an additional 8.7 million people that year. A 19 percent cut in funding for USAID under the President’s fiscal year 2014 budget proposal raises an even greater risk that those challenges will remain unaddressed.
The report, Accelerating Impact: Expanding Access to Care outlines USAID’s achievements in TB prevention and care, collaborative interagency activities, and USAID’s partnership with the Global Fund to Fight AIDS Tuberculosis and Malaria.
The report indicates that TB deaths decreased by 35 percent, and prevalence decreased by 37 percent between 1990 and 2011 in 40 USAID-supported countries. The report also indicates that the world is on track to meet the Millennium Development Goal of a 50 percent reduction in mortality by 2015. The U.S. has committed to contributing to this goal by successfully treating at least 2.6 million new TB patients, and supporting the diagnosis and treatment of at least 57,200 multidrug-resistant TB patients.
USAID-supported programs successfully treated 1.5 million TB patients in 2011, representing an 86 percent treatment success rate. In addition, over 44,000 MDR-TB patients were enrolled in U.S.-supported programs in 2011 – a big increase compared to the year before when 19,000 MDR-TB patients were enrolled.
Despite these successes, the fact remains that about a third of the estimated number of people infected with TB do not have access to quality diagnosis and treatment services. Even with access to free diagnostic services and treatment, people from the most vulnerable populations infected with TB are subject to a significant economic burden, due to loss of income, transportation costs, and other expenses. The report estimates that some countries lose four to seven percent of their GDP because of TB.
A consistent increase in drug resistance, particularly in Eastern Europe and Central Asia further complicates the global TB response. An estimated 630,000 cases of MDR-TB, more difficult to diagnose and treat than drug-susceptible TB, require at least 18-24 month regimens of expensive drugs, with potentially toxic side effects, in addition to more costly specialized laboratory expertise and infrastructure.
Proposed budget cuts to the President’s Emergency Plan for AIDS Relief may further hamper the global TB response, as PEPFAR leads the US response to TB-HIV co-infection while the HIV epidemic continues to drive the spread of TB in countries where these synergistic diseases are highly prevalent. At least one-third of the 34 million people living with HIV are infected with latent TB, and almost 80 percent of these patients live in sub-Saharan Africa. The report says that in 2011, only 48 percent of all people co-infected with HIV and TB were started on antiretroviral treatment.
At the same time that an intensified response is needed to reach those left out from the current gains, new diagnostic tools, treatments and a vaccine will be necessary. The contributions the U.S. has made to global TB responses have been valuable, the report concludes, but without focus, they will not last.