New figures released yesterday by the World Health Organization (WHO) show that there were over 9 million new cases of tuberculosis (TB) and 1.7 million TB deaths in 2006. Although this was a fall on the year before, the figures suggest that efforts against the disease may be slowing.
The report also warned that progress against drug-resistant TB was far short of what is needed.
Statistics gathered by WHO from national government reporting systems suggest that total TB prevalence in 2006 was 14.4 million. Of these, 9.2 million were new TB cases. Incidence of TB fell by 0.6% compared to 2005, but because of the increase in the world’s population there were actually more new TB cases in 2006 than in 2005.
Deaths from TB fell compared to the year before, but WHO’s statistics showed that there was a slowing of the decline in TB mortality compared to 2001 – 2005. Of the 1.7 million TB deaths seen in 2006, some 200,000 were in people with HIV.
In all regions of the world, reductions in TB mortality were below WHO target levels. Africa and Europe (including Eastern Europe and Russia) were furthest from meeting their targets.
But the report also showed that just under 85% of people with TB completed treatment, almost reaching WHO target levels. Nevertheless there was disappointment that despite these high levels of treatment insufficient progress was achieved in reducing both TB prevalence and incidence.
HIV testing increased amongst TB patients, with 12% of individuals diagnosed with TB receiving an HIV test.
Particularly high levels of HIV testing were achieved in eleven African countries which together have over 50% of TB cases in HIV-positive individuals. Three countries – Rwanda (76%), Malawi (64%) and Kenya (60%) were well ahead of the 51% WHO regional HIV testing target.
The number of HIV-positive patients enrolled on antiretroviral treatment programmes more than doubled from 29,000 in 2005 to 76,000 in 2006 in resource limited countries. But screening of HIV-positive patients for TB was well below target. WHO wants 11 million HIV-positive patients to be checked for TB, but in 2006 only 312,000 were screened.
Over 23,000 cases of multi-drug resistant TB (MDR-TB) were diagnosed in 2006, and over half these cases were in Europe (mainly Eastern Europe and Russia). It is estimated that 50,000 patients with MDR-TB will be enrolled in appropriate treatment programmes in 2008, well short of the 98,000 target.
Although $3.3 billion was spent globally on TB control and treatment in 2006 (up from less than $1 billion in 2001), there was still a funding short-fall of $385 million, with only 22 countries reporting that they had enough funds for their TB programmes.
It is estimated that TB funding will have to increase by a further $1 billion to meet the demands of TB/HIV treatment programmes and the management of MDR-TB and extensively-drug resistant TB (XDR-TB).