Fighting tuberculosis – the disease that doesn’t go away
Getting on top of the tuberculosis epidemic requires renewed attention, and bringing HIV out of isolation.
Another year, another Global Tuberculosis (TB) Report that tracks too slow progress towards ending TB, one of the world’s oldest and deadliest diseases.
Released in the run-up to the first-ever UN High-Level Meeting on TB, being held on 26 September 2018, the message from the World Health Organization (WHO) is clear: we are not on target to meet global goals which call for a 90% reduction in TB deaths and an 80% reduction in annual TB cases from 2000.
TB disproportionately affects low- and middle-income countries, and particularly those people living and working in impoverished and overcrowded conditions. The epidemic is complex, with overlapping challenges relating to HIV/TB co-infection, as well as a looming public-health crisis around drug-resistant TB.
According to the new report, 10 million people developed TB in 2017, 9% of these were also living with HIV, which increased to 72% in Africa. Two-thirds of all TB patients resided in in eight countries: India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (5%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).
In 2017, an unacceptable 1.6 million people died from TB – a disease which is both preventable and treatable – and 300,000 of those were among people living with HIV. The good news is that deaths are falling, just not at the rates that they should be. There’s been a 29% decrease in TB deaths among HIV-negative people, and positively, it’s fallen by 44% among people co-infected with TB/HIV. Since 2000, new cases of TB have also fallen by 2% per year between 2013 and 2017, with faster reductions in Europe (5%) and Africa (4%).
But the rise and prevalence of drug-resistant TB are at crisis point, says the WHO. Worldwide, over half a million people had resistance to first-line treatment for TB – and 82% of this group had multi-drug resistant TB. The proportion of cases which are considered ‘extensively’ drug resistant has increased, from 6.2% to 8.5%. This presents a major problem for treating TB, and particularly in low-resourced settings where there may be no access to alternative therapies.
For people living with HIV, TB is dangerous because its onset can be triggered by a weakened immune system. They are 21 times more likely to develop active TB than an HIV-negative person, which is why it is especially important for people living with HIV to be tested and on suppressive antiretroviral treatment (ART). But in 2016 just 60% of TB patients were tested for HIV – up from 58%. In Africa, the region with the highest burden of HIV-associated TB, the stats are better with 86% of TB patients with a documented HIV test. Of all reported cases, around 84% of HIV-positive people with TB were on ART.
Diseases like HIV and tuberculosis are overlapping and carry similar characteristics – including transmission routes, the populations they affect, and diagnostic and treatment challenges. Integrating these services into a one-stop-shop can help to strengthen systems and improve efficiency – people don’t come with a diagnosis, after all, they need person-centred responses and services.
“The upcoming United Nations High-Level Meeting on Tuberculosis is a huge opportunity to bring HIV out of isolation and push for the integration of HIV and tuberculosis services,” says Michel Sidibé, Executive Director of UNAIDS. “There have been major gains in treating and diagnosing HIV among people with tuberculosis, but still, decades into the HIV epidemic, three in five people starting HIV treatment are not screened, tested or treated for tuberculosis, the biggest killer of people living with HIV.”
“It is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “We need to join forces to root out this disease that has a devastating social and economic impact on those who are “left behind”, whose human rights and dignity are limited, and who struggle to access care. The time for action is now.”