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Facts About Tuberculosis
With the global eradication of smallpox, and the imminent eradication of polio, tuberculosis, malaria and infection with the Human
Immunodeficiency Virus (HIV) are major causes of sickness and death in many countries of the world. These diseases affect largely
people living in conditions of extreme poverty.
In the last 20 years, some 20 million people have died as a result of being infected with HIV. HIV infected people do not die of the infection
but succumb to HIV-related diseases.
The commonest of these is tuberculosis.
The annual incidence of tuberculosis is 9 million and mortality 2 million. Of these staggering figures, Africa bears the brunt of the
disease. Of the 22 poorest countries in the world, 18 are in Africa. Africa has 14% of the world's population, and yet it has 30% of the
global tuberculosis population and 80% of its HIV infected population.
In spite of the fact that tuberculosis exists largely in southern countries, there is no reason for complacency in countries of Europe and
North America. Large scale migrations will continue to pose a challenge to the eventual eradication of the disease. For instance, the annual
incidence in the United Kingdom, which was approximately 7000 until 2005, has increased to 9000 in 2006.
More concerning is the fact that migrants from Easter European countries may have a higher incidence of drug resistant tuberculosis, whereas
those from Africa may have associated HIV infection which predisposes them to acquire tuberculosis.
Tuberculosis is a curable disease. The treatment cost is approximately 5p a day for 6 months. Yet this curable disease continues to ravage
populations in countries of the southern hemisphere where the vast majority of these populations, despite living in countries rich in natural
resources, subsist on less than one dollar a day. Further, the highest mortality is among men aged between 15 and 40 years. These people, who
could be gainfully employed and contributing to the wealth of their families and country, are, instead, contributing to the drain on the
resources of their families and country.
The current incidence and prevalence of tuberculosis is severely straining the capacity of some National Tuberculosis Control Programmes
(NTCPs) to successfully administer the WHO recommended standard 6-month regimen. Furthermore, it inhibits the attainment of the United
Nations Millennium Development Goals (MDGs) of arresting the incidence of tuberculosis by 2015 and the Stop TB Partnership's goal of
eradication tuberculosis by 2050.
There is universal agreement globally, among services involved in tuberculosis control, that if tuberculosis is to be controlled, treatment
duration will have to be significantly reduced from the current six months to one month or less.
The standard treatment of tuberculosis is a cocktail of drugs for 6 months. This treatment has high cure rates if taken for the total duration.
It is universally agreed that, if tuberculosis is to be eradicated through treatment, then treatment duration will have to be reduced substantially
in order to improve compliance from both the patients and the treatment services. However, to be able to reduce duration further will require the
development of new and more potent drugs. There has been no new drug development for tuberculosis for 50 years.
In recent years several pharmaceutical companies have begun to test new compounds for tuberculosis. However, the estimated development of a new
anti-tuberculosis drug, from discovery to marketing, is, at least, 20 years at an estimated cost of one billion dollars for each drug. Since
tuberculosis is treated by several drugs, these costs cannot be met by a single organisation.
The potential for currently used drugs to reduce treatment duration has not been fully explored even though there is evidence that duration
can be reduced by increasing the dose of some of these drugs. And, although it will not be possible to reduce treatment to below 3 months, a
50% reduction in duration would have a significant beneficial impact on the patients' lives and on the NTCPs.
Since the discovery of streptomycin in 1944, clinical trials have played a pivotal role in the improvements in treatment of the disease as
well as the reduction of treatment from 2 years to 6 months.
All treatment advances for tuberculosis, such as the establishment of domiciliary treatment, as well as the reduction of treatment duration,
have been made through carefully and rigorously conducted clinical trials.
Such clinical trials will continue to have a pivotal role in defining treatment schemes which will further reduce treatment duration, improve
compliance and reduce the burden of administration for the NTCPs.
World Without TB aims to achieve a reduction
in treatment duration through clinical trials of currently used
drugs. This will be done through a series of rigorously conducted
trials to test whether an increase in the dose can be safely
achieved and whether this increase can lead to a reduction in
treatment duration from the current 6 months to 3 months.
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