HIV/AIDS adds new dimension to TB threat

HIV/AIDS has changed the face of Africa's tuberculosis (TB) epidemic, which is now reaching alarming proportions, a new World Health Organisation (WHO) report, released on World TB Day, has found. While most areas of the world have managed to curb the spread of the disease, TB incidence rates have tripled since 1990 in African countries with high HIV prevalence, and the numbers are still rising, warned WHO's Global Tuberculosis Control report for 2005. For HIV-positive people, TB is the most frequent opportunistic infection and the leading cause of death. About 12 million people are co-infected with HIV and TB, and two-thirds of them live in sub-Saharan Africa. Among African countries, Nigeria, with the third highest HIV caseload in the world, has the highest estimated number of new TB cases annually. But the political commitment shown following the Abuja Declaration, where African leaders committed themselves to allocating at least 15 percent of their annual budgets to the health sector, has not yet been translated into strong support for health systems, WHO said. According to the report, this had discouraged a number of external donors, including the Global Fund, who have been reluctant to provide more resources to help a country fight TB where governments have demonstrated a lack of vigour. Despite being widely regarded as a success story in lowering the rates of HIV/AIDS, Uganda is currently curing fewer TB patients than it did four years ago. More than half of all people with TB in Uganda remain without access to Directly Observed Treatment Short-course (DOTS) services due to strained general health facilities. In South Africa, the government has made TB control a priority and the DOTS strategy has been implemented in all provinces, but at 53 percent, treatment success rates remain low and many patients are not being followed up. "A concerted effort will be needed if South Africa is to reach the target cure rates," it warned. "TB killed more people than all wars, earthquakes, floods, tsunamis, airline accidents, terrorist acts and murders worldwide the past year, but with much less fanfare," Dr Bobby John, head of a global advocacy campaign, Massive Effort, said in a statement. Nevertheless, the WHO report provided "real optimism that TB is beatable, but it is also a clear warning," Director-General Dr Lee Jong-wook said on World TB Day. He called for "urgent action in Africa on the two epidemics together." Although there has been very little collaboration between TB and HIV/AIDS control programmes, African countries were slowly beginning to develop and improve access to prevention, treatment and support services, for both TB and HIV/AIDS patient, WHO noted. The UK-led Commission for Africa, which linked improved TB control to strengthened health systems, will also be lobbying for full funding of WHO's 'Two Diseases, One Patient' strategy for improved TB and HIV intervention. As more money for flowed TB control increasingly became available, however, countries had to now show that they could spend the funds effectively, the report concluded. To access the report: www.who.int