Sunday, 24 April 2011

TUBERCULOSIS: Three African health ministers make the case for consigning TB to medical history

April 19, 2011
Dr. Aaron Motsoaledi, Dr. Mphu Ramatlapeng, and Mr. Benedict Xaba are, respectively, the ministers of health from South Africa, Lesotho, and Swaziland.
Today marks a historic step in the fight against infectious disease in the developing world. As the health ministers of South Africa, Swaziland, and Lesotho, we stand united in purpose to call on the international community to help us move toward eliminating tuberculosis from the planet.
That goal might seem overambitious or unrealistic. It's not. Cheap, effective treatments for TB already exist. The standard antibiotic cocktail costs just $20. Countries around the world have proven that they can cure over 85 percent of TB patients once detected and provided with proper treatment.
One obstacle to eliminating TB has been the lack of a reliable and rapid tool for diagnosing the disease. Nearly a third of all tuberculosis cases go undetected. Each undetected case goes on to infect an average of 15 additional people annually. It's therefore no wonder that we've been unable to break the global tuberculosis epidemic, which has killed an estimated 100 million people since 1960.
But thanks to recent technological breakthroughs, as part of a comprehensive approach to TB control and management, we may now be able to overcome this hurdle.
In 2009, there were 9.4 million new TB infections, and an estimated 1.7 million died from the disease. Africa was hit hardest—the continent is home to 30 percent of the globe's TB cases despite comprising just 11 percent of its population. In Swaziland, the World Health Organization estimates that 1,257 new TB cases occur annually for every 100,000 people. Swaziland's government has declared the TB situation a national emergency.
The TB problem isn't confined to adults. In Uganda, Tanzania, Zimbabwe, and South Africa, over 16 percent of TB patients are children. The continued prevalence of TB has also hampered the fight against HIV/AIDS. Patients with compromised immune systems are easy targets for TB. TB is the leading cause of death among HIV-positive Africans. Of the 380,000 people with both diseases that die each year, 80 percent live on our continent.
Fortunately, we see a great opportunity with a cutting-edge TB diagnostic called "GeneXpert," which was recently announced and certified by the World Health Organization. The first major scientific advancement in the battle against TB in nearly 50 years, GeneXpert could end our struggle. GeneXpert can give a 30 percent more accurate result of whether a person has tuberculosis than current tests.
Perhaps more importantly, GeneXpert could prove invaluable in battling drug-resistant tuberculosis, as it can detect drug-resistant bacilli within two hours. Most current tests take three months to do the same.
Many TB patients don't take their medication as prescribed. That can lead to the development of drug-resistant strains of the disease, which are more difficult and expensive to cure.
The World Health Organization estimates that 440,000 people had drug-resistant TB in 2009. About a third of them died that year. In South Africa, researchers have reported cases of the extremely deadly, "extensively drug-resistant" version of TB in every province, including an alarming 468 cases in the town of Tugela Ferry alone.
Since its identification in South Africa, extensively drug-resistant TB has been diagnosed in many parts of the world. Africa's ability to detect drug-resistant TB is limited, partly because of inadequate numbers of top-notch laboratory facilities.
While drug-resistant forms of TB have been difficult to diagnose with current technology, the new GeneXpert tool accurately detects drug-resistant TB 95 percent of the time.
In addition, GeneXpert will assist in the fight against HIV. For every 100 people living with HIV who have active TB, GeneXpert successfully detects the disease in 80 of them. A traditional diagnostic test finds it in just 40 of them.
The South African government, with support from the United States, began rolling out GeneXpert in every province on World Tuberculosis Day, March 24.

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