The total number of new tuberculosis (TB) cases remained stable in 2007, and the percentage of the world's population becoming ill with TB has continued the slow decline that was first observed in 2004, according to a new report released by WHO.
However, the 2009 global TB control report also reveals that one out of four TB deaths is HIV-related, twice as many as previously recognized. In 2007, there were an estimated 1.37 million new cases of tuberculosis among HIV-infected people and 456 000 deaths. This figure reflects an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years.
"These findings point to an urgent need to find, prevent and treat TB in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases," said Dr Margaret Chan, director-general of WHO.
The report reveals a sharp increase in HIV testing among people being treated for TB, especially in Africa. In 2004, just four per cent of TB patients in the region were tested for HIV; in 2007 that number rose to 37 per cent, with several countries testing more than 75 per cent of TB patients for their HIV status.
Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need. In 2007, 200 000 HIV-positive TB patients were enrolled on co-trimoxazole treatment to prevent opportunistic infections and 100 000 were on antiretroviral therapy.
"We have to stop people living with HIV from dying of tuberculosis," said Michel Sidibe, executive director of UNAIDS. "Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives."
TB/HIV co-infection and drug-resistant forms of tuberculosis present the greatest challenges, the report says. In 2007 an estimated 500 000 people had multidrug-resistant TB (MDR-TB), but less than one per cent of them were receiving treatments that was known to be based on WHO's recommended standards.
Given the current financial crisis, the report documents concerns over an increasing shortage in funding. Ninety-four countries in which 93 per cent of the world's TB cases occur provided complete financial data for the report. To meet the 2009 milestones in the Stop TB Partnership's Global Plan to Stop TB, the funding shortfall for these 94 countries has risen to about US$ 1.5 billion. Full funding of the Global Plan will achieve its aim of halving TB prevalence and deaths compared with 1990 levels by 2015.
"We have made remarkable progress against both TB and HIV in the last few years. But, TB still kills more people with HIV than any other disease," said Dr Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "The financial crisis must not derail the implementation of the Global Plan to Stop TB. Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide."
The release of the report coincides with World TB Day and a 1500-strong gathering at the 3rd Stop TB Partners' Forum in Rio de Janeiro. Next week health leaders and ministers will gather in Beijing in a meeting organized by WHO, the Ministry of Health of the People's Republic of China and the Bill & Melinda Gates Foundation with the aim of securing commitments to actions and funding for drug-resistant TB.