Epidemiology of tuberculosis in the Americas: the Stop TB strategy and the Millennium Development Goals

Epidemiology of tuberculosis in the Americas: the Stop TB strategy and the Millennium Development Goals
By: P. Ramon-Pardo, M. Del Granado, A. Gerger, J. Canela Soler, M. Mir, R. Armengol, R. A. Lopez Olarte, R. Rodriguez
INT J TUBERC LUNG DIS 13(8):969–975

BACKGROUND: Tuberculosis (TB), a preventable and
curable disease, remains a major public health threat in
the poorest regions of the Americas. The DOTS strategy
was implemented to control TB in the region in 1993,
and the new Stop TB strategy, emphasizing high-quality
DOTS expansion, in 2006.

OBJECTIVES: To describe TB epidemiology in the region
of the Americas from 1994 to 2005 and to analyze
the progress made towards and prospects for achieving
Goal 6 of the Millennium Development Goals (MDGs)
by 2015.

METHODS: TB incidence, mortality and prevalence rates
as well as DOTS coverage and DOTS treatment success
rates were collated from the World Health Organization
(WHO) databases from 1994 to 2005.

RESULTS: DOTS coverage and DOTS treatment success
rates rose steadily from 1994 to 2005, with 88% of the
population covered under DOTS by 2005, and an 80%
success rate by the end of 2004. The TB incidence,
prevalence and mortality rates have also decreased steadily
from 1994 to date, but differ with respect to the various
scenarios.

CONCLUSIONS: With the exception of some countries,
further reduction in TB incidence, prevalence and deaths
by 2015 is possible. Widespread implementation of DOTS
should continue in order to meet WHO targets and attain
the MDGs.

While this study definitely shows encouraging data through 2005, the authors importantly highlight that "Several factors, such as multidrug-resistant TB (MDR-TB), in the Region of the Americas have made effective TB control in certain countries extremely diffi cult and challenging. In 2004, the Dominican Republic, Ecuador, Guatemala and Peru had an MDR-TB prevalence of >3%. As demonstrated, the HIV/acquired immunedeficiency syndrome (AIDS) epidemic increases the TB burden.24 In addition to these factors, lack of education, knowledge and employment have led to a rise in poverty, which aggravates the already inequitable access to health services and growth of marginal populations."

In terms of solutions the authors said, "Different interventions, such as addressing TB in vulnerable groups, the implementation of comprehensive strategies to identify respiratory suspects, involvement of private providers in TB control and the efficient use of available resources should be prioritized by scenario. Furthermore, there are limitations to TB control beyond the programs, such as weak health systems, lack of human resources and the threat of the HIV epidemic."

TB Treatment Strategies in South Africa

Given the treatment/hospital quarantine strategy used in South Africa (outlined in the full article), innovative treatment services may encourage more people with TB symptoms to come forward for treatment. Treatment approaches such as this one in South Africa via Doctors Without Borders may be useful in other high-burden and MDR-TB endemic areas around the world.

"...Under South Africa’s current policy, Ms. Vani would normally have been whisked away to a hospital after tuberculosis was diagnosed and isolated from the public for a grueling regimen of toxic, hard-to-tolerate pills and injections, lasting months.

In the neighboring Eastern Cape Province, patients have effectively been imprisoned in a hospital encircled by fences topped with razor wire, and dozens of them have escaped in desperate bids to reunite with their families. Both the Eastern Cape and Western Cape Provinces have sought court orders to compel the return of runaways.

But in this case, Ms. Vani is being treated in a local clinic and lives at home under a pilot program run by Doctors Without Borders and supported by both the city of Cape Town and Western Cape Province. The idea is to show that such patients can be successfully treated in an impoverished community like Khayelitsha even while they are still infectious.

For Ms. Vani to continue in the program, Ms. Beko had to ensure that the young woman could live at home during her treatment with minimal risk of infecting others. Tuberculosis spreads through the air when patients cough and sneeze, and the germs could get trapped in the tiny room where Ms. Vani lives alone..."

Full article at:
http://www.nytimes.com/2009/07/29/world/africa/29safrica.html