Tuberculosis: neglected aspects of the disease under the spotlight in Rio

Africa's TB gap

Africa faces the largest funding gap to implement the Global Plan to Stop TB by 2015.

During the Rio meeting, the Africa Public Health Alliance launched a campaign - “African TB Partners Call on African Heads of State, Health and Finance Ministers to fund the gap in the fight against TB”. A Kenyan activist Lucy Cheshire said that African health ministers recognised TB as an emergency but, nevertheless, were failing to mobilise the resources required to control TB and fully implement the Global Plan.

“The current global economic crisis is all the more reason why high-burden TB countries in Africa should invest in TB control. As per a report of World Bank and Stop TB Partnership, high-burden TB countries are likely to recover 9-15 times of their investment in TB control”, said Mayowa Joel of Nigeria. The report indicated that the economic cost to Africa of not treating TB between 2006 and 2015 would be US$519bn, while TB could be controlled for US$20bn in the same period.

Many organisations signed up to the Alliance's call during the meeting. Further information can be obtained from Lucy Cheshire at or Mayowa Joel at .

Over 4.2 million Africans are currently living with TB and of these 2.8 million are new TB cases. An estimated 639,089 African lives are lost to TB annually. Even though Africa makes up only 11.7% of the global population, nine of the world's 22 “high-burden” TB countries are in Africa: Democratic Republic of Congo (DRC), Ethiopia, Mozambique, Nigeria, South Africa, Uganda, Kenya, Tanzania and Zimbabwe. The high prevalence of HIV and recent outbreaks of multi-drug resistant tuberculosis (MDR-TB) add further to the seriousness of the African TB situation.

Indigenous peoples

There are approximately 370 million indigenous (or “first nations”) peoples globally, living in more than 70 countries. They have often been neglected by TB programmes as a result of cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than they are in other people living in the same countries. For example, in Canada during the five-year period 2002-2006, the first-nations TB rate was 29 times higher than other Canadians; for the Inuit people, it was 90 times higher.

Speaking in Rio, Wilton Littlechild, Regional Chief, Assembly of First Nations, said: “Due to a broad range of reasons, indigenous people aren't able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance ...We demand inclusion of indigenous peoples in the Global Plan to Stop TB strategy and have launched a strategic framework aimed at addressing tuberculosis among indigenous peoples .... We wish to establish a secretariat to collect data of TB programmes in indigenous communities.”

Chief Littlechild said the strategic framework had been developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It was designed to take an indigenous approach, linking the right to health, education, housing, employment and dignity. It was based on equality of opportunity to the highest level of health attainable worldwide. The framework would serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions, and to monitor TB trends among indigenous peoples. The framework also called upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

Neglect of people with MDR-TB

Médecins Sans Frontières (MSF) says that less than 1% of people with multi-drug resistant TB (MDR-TB) get access to proper treatment, as defined in international guidelines.

WHO puts the figure a little higher. Dr Ernesto Jaramillo, Medical Officer of WHO's Stop TB department told the Rio meeting that: “Only 3% of people who have MDR-TB have access to effective treatment. We have compelling evidence that we know how to prevent and treat MDR-TB and treatment success rate is 80% in low-resource setting. Its intervention is complex but is effective, feasible and is cost-effective”. Dr Mario Raviglione, Director of Stop TB, said that that there could be more than half a million MDR-TB cases every year and that 54 countries had now reported the presence of extensively drug-resistant TB (XDR-TB).

In 2007, MSF treated 574 patients for MDR-TB in 12 projects including in South Africa , India , Uzbekistan , Georgia and Armenia. The organisation is concerned that many countries, particularly those classified by WHO as “high-burden” - such as China, South Africa or India - are not doing enough to provide treatment to patients in need. In addition, not providing appropriate treatment further contributes to the spread of drug-resistant TB.

China, for example, has a quarter of the world's MDR-TB cases. Answering an initial request made by the Chinese National TB Programme, MSF has since failed to obtain the authorisation to provide care for MDR-TB patients in Inner Mongolia, despite two years of negotiations with national, provincial and regional authorities. MSF has now abandoned its attempts to open the project. “Not being able to act when there are people that need life-saving treatment is extremely frustrating,” said Meinie Nicolai, MSF Director of Operations.

“The slow progress in treating people with MDR-TB is particularly striking because high-burden MDR-TB countries are definitely not the least developed in the world,” said Dr Tido von Schoen-Angerer, Director of MSF's Access to Essential Medicines Campaign. “They have the capacity to act, and need to make this a priority and put people on treatment.”

Dr Jaramillo said that progress was also possible in low-resource countries; Lesotho was able to create a state-of-the-art laboratory for diagnosis of MDR-TB in only six months. “We have countries like Nepal, Philippines, Peru that despite weakness in health systems are providing universal access to MDR-TB diagnosis and treatment”, said Dr Jaramillo.

A high-level ministerial meeting on M/XDR-TB is now about to begin in Beijing, China, for. MSF says it will seek commitment to treating more people with MDR-TB, and to conducting the research necessary to improve current treatment options.

Article published courtesy of TropIKA