Combating TB

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Tuberculosis is a child of poverty and a sister of HIV and AIDS. In 2004 it killed nearly 2 million men, women and children worldwide. The good news is, thanks to better methods of disease control, global deaths is starting to decline. The bad news is the TB problem is worsening in sub-Saharan Africa, where HIV rates are high. Tuberculosis and HIV feed off each other: They are entwined in a deadly co-epidemic that must be confronted by African countries expanding TB treatment as China, India, Indonesia and the Philippines have done.

The World Health Organization confirmed last week TB cases have dropped nearly a quarter worldwide since 1990. The key to this has been the Directly Observed Treatment, Short Course (DOTS) strategy of diagnosis and treatment, now used in 182 countries. DOTS is cheap, costing as little as $10 for a six-month supply of drugs, and remarkably effective with high cure rates even in poor countries. In less than a decade, DOTS programs have treated more than 17 million people.

So TB is treatable -- it is a disease which we can beat. The U.N.'s Millennium Development Goals (MDGs) include targets for TB control, and globally the tide is turning in our favor. WHO estimates most regions are on track to meet the MDGs of cutting in half the number of TB cases and deaths by 2015.

So how does TB persist, and can DOTS beat it?

The disease continues to rear its head wherever poverty or deprivation is found. In more developed countries -- particularly Eastern Europe and the former Soviet Union -- TB has re-emerged as a threat alongside social and economic crises. TB also strikes where HIV is widespread.

In the worst-affected African countries, like Malawi and Kenya, up to 80 percent of TB patients are HIV-positive: The immune system breakdown that comes with HIV and AIDS opens the door for TB, the leading killer of HIV-positive people.

DOTS programs are straining under the pressure, especially in Africa where limited numbers of health workers and inadequate health facility networks create obstacles to care, especially for the poorest and most vulnerable. This means TB sufferers are not found in time. And if found in time, they cannot be supervised through their treatment.

We are confident we have the means to beat TB. Despite their limitations, our existing methods have enabled us to increase discovery and cure of TB cases each year. And our increased investment in research and development promises new drugs, diagnostics and vaccines that can revolutionize TB control and eventually end this public-health threat.

The main challenge now is to strengthen the systems that deliver public health services by improving methods of controlling TB, especially in Africa where we must fight HIV and TB together. This means offering HIV testing and where possible, anti-retroviral drugs to TB patients -- while also screening those infected with HIV for tuberculosis and providing them effective TB treatment. "We can't fight AIDS unless we do much more to fight TB," former South African President Nelson Mandela said last year.

With the Stop TB Partnership at the helm, our cooperation is the key. Cooperation works at the local level, where public and private health clinics, workplace TB programs, local communities and schools all have a role to play in fighting the disease. We have seen very effective national partnerships set up in countries like Uganda, Pakistan and Mexico.

At the global level, we estimate $2.2 billion is needed to control TB in 2005 -- and we are $1 billion short. We need more donor funds, coupled with more funds from developing country governments. At Abuja in 2001, African countries pledged at least 15 percent of their own budgets to health: none have so far met that target. We estimate 80 percent of the money needed for health will go toward expanding medicines and human resources needed to strengthen DOTS.

The last decade has shown we can win the battle against TB. But HIV and AIDS now cast a dark shadow over our ability to fight that battle in Africa. Our approach there, as everywhere, must be to invest our best efforts in the people, systems and drugs needed to detect and treat the disease.

Andrew Natsios is administrator for the U.S. Agency for International Development. Aileen Carroll is Canadian minister of international cooperation. Hilary Benn is the United Kingdom's secretary of state for international development. The U.S., Canada and the U.K. are the three largest donors in the global Stop TB Partnership.