By the time Azmara Ashenafi’s multidrug-resistant tuberculosis was diagnosed, she had been wasting away, coughing and running fevers for three years. She had been on ineffective treatment for six months. Her three-year-old son had drug-resistant TB as well.
The story of the young Ethiopian mother is highlighted in USAID’s Fiscal Year 2013 report, Impact and Leadership, U.S. Government Report on International Foreign Assistance for Tuberculosis, to illustrate the need, accomplishments, and work yet to be done by the agency that leads the U.S. Global TB response.
The cumulative progress since 1990 in the 27 countries with tuberculosis responses supported by USAID that is reported in the document is marked, including a 41 percent drop in deaths from tuberculosis, a 40 percent drop in prevalence of the disease across those countries, the successful treatment of 1.32 million people with tuberculosis, and the appropriate treatment of more than 45,000 people with drug-resistant disease. The report also details how testing for HIV among TB patients, along with screening for TB among people living with HIV has increased. While the report notes that efforts must expand to provide antiretroviral treatment for patients co-infected with HIV and TB, it notes improvement there as well, with 57 percent of co-infected patients receiving treatment for HIV.
But amid the strides, gaps and warnings remain. HIV continues to fuel the spread of TB, and among people with both illnesses death rates remain high. An estimated 3 million people sick with TB are undiagnosed. Untreated they continue to spread disease. Inappropriately treated, their disease becomes resistant to drugs and they transmit that disease. Many of the estimated 600,000 people with multdrug-resistant TB remain undiagnosed and untreated, the report says. And while rising urbanization also has fueled the spread of TB, urban centers in the most heavily burdened countries are projected to grow only more crowded in the next 15 years.
The Ethiopian mother and her three-year-old son whose illness and diagnosis are described in the report have another year of treatment ahead of them at the time their story leaves off. The work to reach a world free of TB stretches into an unknown future, the report notes, with a new strategy that will require continued research, development, leadership and investment. The report includes timelines, breakdowns of investments as well as of accomplishments, and progress reports from each of the 27 countries receiving direct USAID support.