World TB Day News Release: Restrictions in TB control strategy leave the poorest untreated

Whilst the World Health Organisation-embraced strategy for controlling tuberculosis (TB) has been successful in treating and curing TB, its current format restricts the extension of this success to the poor: although TB treatment is free, diagnosis is not, and so the first gateway to treatment is often shut to the poorest. The restrictions, caused primarily by lack of funds, are outlined in a specially commissioned id21 report by Dr Bertie Squire of the Liverpool School of Tropical Medicine, which points to the tasks ahead if the WHO target to halve TB deaths by 2010 is to be achieved.

According to the WHO, more than 20,000 people develop active TB every day. Five thousand die. The vast majority of these people are in Africa and Asia, where the environmental conditions of poverty - overcrowding, inadequate ventilation and malnutrition - more readily aids the human-to-human transmission of TB infection. Yet it is precisely these countries which currently lack the finance and human resources to comprehensively tackle TB.

As Squire explains, DOTS (directly observed treatment, short course) is the internationally recognised and WHO-embraced strategy for controlling TB, which involves free delivery of short course treatment, and direct patient observation to ensure each prescribed dose is taken correctly. Yet whilst under the DOTS strategy TB medications are free, diagnosis is not. This severely hampers TB control within the world's poorest populations, amongst whom TB is most prevalent.

Restrictions in access to diagnosis are common in many TB programmes in poor countries which lack even the resources to adequately estimate the extent of local TB infection rates. Without such accurate estimates, 'most TB programmes do not know how many TB cases they should be diagnosing and treating each year', Squire writes. Simply put, 'too many cases amongst the poor remain uncounted'.

Squire, Senior Lecturer in Clinical Tropical Medicine and Manager of a UK Department for International Development TB Knowledge Programme, argues that it is now vital to reduce financial barriers to TB diagnosis for the poor. Reducing such barriers requires sustained efforts from governments and donors on two fronts. The first front involves opening up access to diagnosis to the poor. The ultimate aim here should be to make the costly laboratory-based tests required for reliable diagnosis universally free, but advances could also be made in the development of cheaper, non-laboratory reliant diagnostic tools, as well as in maximising access points through public-private partnerships, for example. The second, equally important front, involves directing resources towards increasing national TB programmes' abilities to estimate the number of TB cases within their populations, through the development and strengthening of capacities in surveying and demographic analysis. Only if these two fronts are properly tackled, Squire concludes, can the potential within the DOTS strategy to cure TB be extended to the global poor.

Notes to Editors

Dr. Bertie Squire's article 'What the patient ordered - meeting the needs of TB patients' has been specially commissioned by id21 to mark World TB Day, March 24, 2003. Members of the press at can view an embargoed copy of the article at: http://www.id21.org/health/h4bs2g1.html. Reproduction is welcomed and free - contact Sally Gainsbury [email protected] , tel: + 44 (0) 1273 877305 or +44 (0) 7989 560637 to arrange.

For further information, and to arrange an interview with Dr. Squire, contact Sally Gainsbury, id21 Research Editor, on 44 (0) 1273 877305 or +44 (0) 7989 560637, or email [email protected]

Dr Squire's article will front id21's special coverage of World TB Day on March 24, 2003. Visit http://www.id21.org/health from March 24th , or the links from http://www.id21.org/health/h4bs2g1.html now to view additional TB-research highlighted by id21.

Further information about the WHO's Stop TB campaign can be found at: http://www.stoptb.org/world.tb.day/default.asp. The campaign also provides access to a TB imagine library at: http://stoptb.lpipserver.com/ and lists the following facts:

* 2003 marks the 10th anniversary of TB being declared a global emergency by the World Health Organization (WHO). This is the only such emergency ever declared by WHO, and it remains in effect today.
* According to WHO estimates, by March 2003, 10 million TB patients will have been treated with DOTS, a milestone that will be commemorated on WTBD in conjunction with the 10th anniversary of the Global Emergency.
* Two million people die of TB every year, more than ever before in history. Yet TB is curable: DOTS, the internationally recommended treatment strategy, cures patients, saves lives and prevents disease transmission.
* Only 30% of people infected with TB currently receive DOTS treatment. Increased funding and political commitment is needed to accelerate DOTS expansion and case detection in order to reach global TB control targets by 2005.

Further information on the DFID TB Knowledge Programme 'Quality Assured TB Care for Poor People in Resource Constrained settings' managed by Dr. Squire at the Liverpool School of Tropical Medicine can be found at the programme website
http://www.liv.ac.uk/lstm/trop/trop8.3.htm

id21 is a fast-track research reporting service funded by the UK Department for International Development (DFID). id21's website http://www.id21.org provides instant access to a fully-searchable database of over 2000 reports on current social, economic, education and health research on developing and middle income countries. To subscribe to periodic email alerts on new research visit http://www.id21.org/id21-email/email.html

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