Hard-to-cure TB poses new global health threat

In the wake of World TB Day, TB has been in the headlines more. This latest article highlights MDR and XDR TB and problems in China with TB, including stories of how anti-TB treatment has bankrupted already impoverished TB victims.
http://news.yahoo.com/s/ap/20090330/ap_on_re_as/as_china_dangerous_tb

For the Americas, Brasil remains in the top 22 high burden TB countries. This new report offers updated information, epidemiological data, and key steps forward.
http://www.who.int/tb/publications/global_report/2009/en/index.html

Of note from the key points summary:
-The main targets for global TB control are (i) that the incidence of TB should be falling by 2015 (MDG Target 6.c), (ii) that TB prevalence and death rates should be halved by 2015 compared with their level in 1990, (iii) that at least 70% of incident smear-positive cases should be detected and treated in DOTS programmes and (iv) that at least 85% of incident sputum smear-positive cases should be successfully treated. The latest data suggest (i) that the incidence rate has been falling since 2004, (ii) that prevalence and death rates will be halved in at least three of six WHO regions by 2015 compared with a baseline of 1990, but that these targets will not be achieved for the world as a whole, (iii) that the case detection rate reached 63% in 2007 and (iv) that the treatment success rate reached 85% in 2006.

-Globally, there were an estimated 9.27 million incident cases of TB in 2007. This is an increase from 9.24 million cases in 2006, 8.3 million cases in 2000 and 6.6 million cases in 1990. Most of the estimated number of cases in 2007 were in Asia (55%) and Africa (31%), with small proportions of cases in the Eastern Mediterranean Region (6%), the European Region (5%) and the Region of the Americas (3%). The five countries that rank first to fifth in terms of total numbers of cases in 2007 are India (2.0 million), China (1.3 million), Indonesia (0.53 million), Nigeria (0.46 million) and South Africa (0.46 million). Of the 9.27 million incident cases in 2007, an estimated 1.37 million (14%) were HIV-positive; 79% of these HIV-positive cases were in the African Region and 11% were in the South-East Asia Region.

- Although the total number of incident cases of TB is increasing in absolute terms as a result of population growth, the number of cases per capita is falling. The rate of decline is slow, at less than 1% per year. Globally, rates peaked at 142 cases per 100 000 population in 2004. In 2007, there were an estimated 137 incident cases per 100 000 population. Incidence rates are falling in five of the six WHO regions (the exception is the European Region, where rates are approximately stable).

-The estimated numbers of HIV-positive TB cases and deaths in 2007 are approximately double the numbers published by WHO in previous years. This does not mean that the number of HIV-positive TB cases and the number of TB deaths among HIV-positive people doubled between 2006 and 2007. New data that became available in 2008, particularly from provider-initiated HIV testing in the African Region, were used (i) to estimate the numbers of cases and deaths in 2007 and (ii) to revise previous estimates of the numbers of cases and deaths that had occurred in earlier years. The numbers of HIV-positive TB cases and deaths are estimated to have peaked in 2005, at 1.39 million cases (15% of all incident cases) and 480 000 deaths.

-The Stop TB Strategy is WHO’s recommended approach to reducing the burden of TB in line with global targets. The six major components of the strategy are: pursue high-quality DOTS expansion and enhancement; address TB/HIV, MDR-TB, and the needs of poor and vulnerable populations; contribute to health system strengthening based on primary health care; engage all care providers; empower people with TB, and communities through partnership; and enable and promote research. The Stop TB Partnership’s Global Plan to Stop TB, 2006–2015 sets out the scale at which the interventions included in the Stop TB Strategy need to be implemented to achieve the 2015 targets.

-The gap between the available funding reported by the 22 HBCs in 2009 and the funding requirements for these countries according to the Global Plan in 2009 is US$ 0.8 billion. The gap between the available funding reported by the 94 countries with 93% of global cases in 2009 and the funding required for these countries in 2009 according to the Global Plan is US$ 1.6 billion. Most of the extra funding required according to the Global Plan is for MDR-TB diagnosis and treatment in the South-East Asia and Western Pacific regions (mostly in India and China), and for DOTS and collaborative TB/HIV activities in Africa.

World TB Day - Supporting Materials

This post is especially for AMSA/PHR/AMA local medical school chapters in the US. My goal as regional coordinator is that the materials assembled here allow for a quick, high-yield World TB Day of outreach.

World TB Day is March 24, 2009. Many of you may have events planned already. For those who do and do not, I have assembed some materials to hand out to classmates and professors.

Setting up a table can be quick, easy, and high-impact!

Consider setting up a World TB Day Table with these and other items relevant to your community. I created a MS-Powerpoint presentation to show or to print out with key, succinct messages related to TB advocacy. If you have any questions, please do not hesitate to contact me.

The materials can be downloaded as a ZIP file from this website:
ZIP file (4 files under the individual materials):
http://www.megaupload.com/?d=8UK64CLP

PAHO (Pan-American Health Organization) Poster for your hallways and table:
http://www.stoptb.org/events/world_tb_day/2009/downlaod/posters/poster_paho_lr.pdf

Individual materials can be downloaded at:
World TB Day PPT Presentation
http://www.megaupload.com/?d=EGUTHQVW

World TB Day Useful Links
http://www.megaupload.com/?d=NQZV3A82

TB Elimination Act 2007 (USA)
http://www.megaupload.com/?d=A67GR9O8

MDR Fact Sheet
http://www.megaupload.com/?d=A00V3JRZ
Additionally, these two links would be great for handouts at a World TB Day:
http://www.who.int/tb/publications/global_report/2008/key_points/en/print.html
http://www.who.int/tb/publications/global_report/2008/summary/en/print.html

Please report if you were able to set up a table, presentation, etc., even if unrelated to the materials that I have included in this post. We are stopping TB.