Tuberculosis: Global Impact and U.S. Response

Although a cure for tuberculosis (TB) was developed more than 50 years ago, TB continues to kill between 2 and 3 million people every year. The World Health Organization (WHO) estimates that 36 million people will die of TB by 2020 if it is not controlled. Eight million people develop active TB every year, nearly 98% of whom live in the developing world.

Studies estimate that households with at least one income-generating member sick with active TB lose three to four month’s work time and about 2% of income. An untreated person with TB loses an average of a full year of work. In the hardest-hit countries, lost productivity due to TB may amount to 4-7% of GDP.

HIV/AIDS and TB are a deadly pair, each speeding the other’s progress. HIV, the virus that causes AIDS, weakens the immune system and greatly increases the chances that someone with a latent TB infection will develop active TB. In fact, people infected with both HIV and TB are over 30 times more likely to develop active TB. TB is the leading cause of death of people living with AIDS, causing nearly one-third of AIDS deaths in the developing world and about 11% worldwide.

Drugs exist to cure most types of TB, but safe, consistent access to them continues to be a problem. Drug resistance, formed usually as a result of partial or inconsistent treatment, is a growing challenge. Resistant strains of TB can only be treated by approaches that are much more expensive to administer and more toxic to the patient.

The most effective method for curing patients, reducing transmission, and preventing the development of drug resistance is the directly observed treatment short-course (DOTS) strategy. DOTS programs incorporate political commitment and resources, laboratory diagnosis of infectious cases, a reliable supply of anti-TB drugs, drug treatment supervised by health or community workers, and monitoring of patient treatment and progress.

Correctly and consistently administered TB treatment can cure TB and extends the lives of people co-infected with HIV and TB from 2-5 years on average. Parents with HIV/AIDS can take care of their children that much longer, reducing the number of orphans and child-headed households, and can continue to contribute economically and socially.

There are important regional dimensions to TB. The WHO estimates 80% of all active TB cases occur in just 22 countries, mostly in Southeast Asia and sub-Saharan Africa. Asia, already home to two-thirds of the people in the world with TB, is facing a growing HIV epidemic that threatens to increase its TB problem. Drug-resistant forms of TB are spreading rapidly in the Newly Independent States of the former Soviet Union, which also have the world’s fastest rates of increase of HIV/AIDS.

U.S. Response

The U.S. is committed to working with its partners to address the global burden of TB. U.S. agencies operate bilateral programs and research activities while working closely with and providing support to innovative multilateral initiatives. In 2003, the U.S. Government, through the U.S. Agency for International Development (USAID) and the U.S. Department of Health and Human Services (HHS), will spend roughly $326 million to fight TB, including $126 million for research and $82 million for international initiatives. In addition, the U.S. is the largest donor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, having pledged $1.65 billion through 2008, 50% of all pledges to date.

USAID supports anti-TB programs in 35 countries. As members of the Stop TB Partnership, USAID and HHS work to expand DOTS around the world and provide direct support to the Partnership. USAID also works through its Rational Pharmaceutical Management Plus program to strengthen drug management systems to support DOTS.

Within HHS, the Centers for Disease Control and Prevention (CDC) works closely with USAID on international control and treatment programs, focusing on DOTS expansion, multidrug-resistant TB, HIV/TB co-infection, and treatment/diagnostic research. Also within HHS, the National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID) is the global leader in basic research on the prevention and treatment of TB. Moreover, the NIH’s Fogarty International Center, in cooperation with NIAID and other U.S. agencies, supports capacity building in several developing countries for TB training and research.