By Ejikeme Omenazu / Lagos
Tuberculosis (TB) treatment has saved the lives of more than 22 million people, according to the World Health Organisation (WHO) Global tuberculosis report 2013 published in Geneva on Wednesday.
The report also revealed that the number of people suffering from tuberculosis fell in 2012 to 8.6 million, with global TB deaths also decreasing to 1.3 million.
The new data confirmed that the world is on track to meet the 2015 United Nations (UN) Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50 per cent reduction in the mortality rate by 2015 (compared to 1990).
According to the report, a special countdown to 2015 supplement to this year's report provided full information on the progress to the international TB targets. It showed if the world and countries with a high burden of TB are "on-track" or "off-track" and what can be done fast to accelerate impact as the 2015 deadline approaches.
The report underlined the need for a quantum leap in TB care and control which can only be achieved if two major challenges are addressed.
The first is that about three million people (equal to one in three people falling ill with TB) are currently being 'missed' by health systems.
Secondly, the response to test and treat all those affected by multi-drug-resistant TB (MDR-TB) is inadequate.
The report stressed that insufficient resources for TB are at the heart of both challenges.
TB programmes, it added, do not have the capacity to find and care for people who are "hard-to-reach", often outside the formal or state health system. Weak links in the TB chain (a chain that includes detection, treatment and care) lead to such people being missed.
"Quality TB care for millions worldwide has driven down TB deaths," says Dr Mario Raviglione, WHO Director of the Global TB Programme.
"But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown."
WHO estimates that 75 per cent of the three million missed cases are in 12 countries.
On the second challenge, the problem is not only that the links in the MDR-TB chain are weak, but that the links are simply not there yet, the report suggests.
WHO estimates that 450 000 people fell ill with MDR-TB in 2012 alone. China, India and the Russian Federation have the highest burden of MDR-TB followed by 24 other countries.
While the number of people detected worldwide with rapid diagnostic tests increased by more than 40 per cent to 94 000 in 2012, three out of four MDR TB cases still remain without a diagnosis.
Even more worrying, around 16 000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem.
Furthermore, many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.
"The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis," says Dr Raviglione.
"It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care.
"We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB."
A further challenge identified relates to the TB and HIV co-epidemic. While there has been significant progress in the last decade in scaling-up antiretroviral treatment for TB patients living with HIV, less than 60 per cent were receiving antiretroviral drugs in 2012. This, the report urged, must improve.
The WHO report recommended five priority actions that could make a rapid difference between now and 2015. These include reaching the three million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and NGOs which serve large proportions of populations at risk.
It also recommended addressing with urgency, the MDR-TB crisis — Failure to test and treat all those ill with MDR-TB carries public health risks and grave consequences for those affected.
High-level political commitment, ownership by all stakeholders, adequate financing and increased cooperation are needed to solve bottlenecks in drug supply and build capacity to deliver quality care.
Also, there should be intensification and building on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV.
