By: Christy Hanson, Chief of Infectious Disease Division, USAID
When I began my career working with Tuberculosis twenty years ago, the outlook for future progress against this biblical disease looked very different than it does today. From 1990 to 2009, the TB community has made tremendous progress—TB related deaths have declined by more than one-third, and incidence is declining globally. The emergence of new diagnostic technologies has made it easier to quickly detect multi-drug resistant TB.
Today, the global incidence rate is falling slowly, and 5 of the 6 regions of the world are on track to meet the UN Millennium Development Goal target to halve TB prevalence and deaths by 2015. We are now looking beyond this goal and are focusing on providing universal access to TB care. This is an effort that will require engaging all providers in the public and private sector, people in communities, and TB patients themselves.
It gives me pause to think this is the same disease that has plagued mankind as far back as the ancient Roman civilization. To understand how this disease has survived for millennia, it is important to know how it works.
This is a disease that is inextricably linked to the socioeconomic realities of the impoverished. TB is activated when an individual’s immune system is weakened by any number of causal factors: old age, malnutrition, pregnancy, HIV, and other concomitant illness, such as diabetes. It is estimated that more than one-third of the population in the developing world who are exposed to these conditions are infected with the disease.
Tuberculosis is one area of health where innovation in diagnostics, treatment and prevention are greatly needed. Current regimens for drug sensitive TB lasts six months. When patients do not adhere strictly to this regimen the disease often mutates and strains emerge that are resistant to the drugs we have in our arsenal and require up to two years of treatment. Due to decades of lesser quality medication and programming that ensured patient adherence we now estimate that there are more than 400,000 cases of multi-drug resistant TB globally.
In Bangladesh scientists recently demonstrated that with a unique combination of drugs currently available, successful treatment of multi-drug resistant TB can be achieved in nine months. These results need to be tested in other epidemiological settings to see if the results can be replicated. If they are successful, a nine month timeframe will become the new gold standard for the development of future drug regimens. USAID is furthering this agenda through targeted research.
USAID is currently investing in technologies that will decrease the length of treatment and improve the effectiveness of medication. Right now we are supporting four new drugs that would shorten regimens from six months to four months. These trials are in late stages which mean they are already being field tested. Our programs will continue to strengthen country-level efforts to provide diagnostic and treatment services. We will also work to expand the involvement of the private sector, integrate TB and HIV care, and encourage treatment of TB at the community level.
By 2015 our programs will contribute to the treatment of 2.6 million TB patients, 57,200 multi-drug resistant cases, and contribute to a 50 percent reduction in TB deaths and disease burden relative to the 1990 baseline.