Fight against TB stepped up

By Henry Neondo

The stop TB Partnership announced Friday the global plan to eliminate tuberculosis in the next ten years effective this year.

The strategy unveiled in Nairobi by the First Zambian President Kenneth Kaunda targets to save 14 million lives by putting 50 million people infected by the TB on treatment.

The Global Plan to Stop Tuberculosis (2006-2015) calls for global tuberculosis spending to triple over the next decade to increase access to tuberculosis control programmes and accelerate research on new tools to fight the disease.

The plan envisages production of new diagnostic tool 100 years when the last similar thing was discovered, have new drugs in the market, 40 years when the last time a drug was discovered and developing a new vaccine, effectively availing one other than the Bacille Calmatte Guerine (BCG) vaccine, usually given to children under five but loses ability to protect one in old age.

It also envisages a budget of USD56 billion with the largest single most cost item being investment in Directly Observed Treatment Short course, DOTS estimated to cost USD 29 billion followed by TB-HIV collaborative efforts at USD 6 billion.

In Kenya, TB remains a big threat to public health. The number of case of TB notified to the National Tuberculosis and Leprosy Programme, NLTP of the Ministry of Health has spiralled from about 10, 000 cases a decade ago to more than 106, 000 in 2005.

It is estimated that in 2004 bout 80, 000 people may have died of TB in Kenya. In Africa, Stop-TB Partnership estimates 1500 people die of TB every day.

Most of these deaths could have been prevented if people had full access to TB diagnosis and treatment services countrywide.

It is not surprising that experts at the WHO have correctly placed TB at the top of the list of causes of death from a preventable and treatable cause.

The TB partnership says that the prospect for reaching the TB Millennium Development Goals looks much more achievable in most parts of the world except for the African continent where the HIV epidemic and the poor performance of health systems impede progress.

It has thus become clearer that achieving MDGs at the global level depends on their achievement in Africa and other high HIV prevalence settings.

In Kenya as elsewhere in Africa, efforts have over the years been made to spread of
TB throughout the pursuit of expansion and improvement of the quality of DOTS, the approach that has been found to be effective for control of TB in such countries as Tanzania and Malawi.

However as noted Dr Enoch Kibunguchy, Assistant Minister for Health that the quality of DOTS cannot occur in the presence of a weak public health care, where one walks for 20 KM to access medical services, end up in a clinic that is undermanned, under funded and under-stocked with requisite medicine.

For this strategy to work, the health care system must be strengthened through the provision of adequate number of competent health care workers, improve and develop the physical infrastructure in which health care is provided and the provision of basic equipment and supplies.

It is encouraging however that the Stop-TB partnership has recognised this and has placed a lot of emphasis on health system strengthening.

The Plan
The Stop TB Partnership has been conscious that the plan must be based on sound epidemiological analysis and robust budget justifications in order to provide a powerful argument for resource mobilisation.

The development of each plan and of the overall Global Plan has therefore been informed by an analysis of the expected impact, with the accompanying costs, of the planned scale-up of activities oriented towards achieving the targets for 2015.

The analysis has required close interaction between representatives of all the 400 Partners, WHO Regional Offices and the team assessing the epidemiological impact and costs of the currently available and new tools.

Scenarios for implementation for 2006 - 2015 have been developed globally and for seven of the eight TB epidemiological regions: Africa, high HIV prevalence, and Africa, low HIV prevalence, which are presented together among American Region (AMR) - Latin American countries (LAC); Eastern European Region (EEUR); Eastern Mediterranean Region (EMR); South-East Asian Region (SEAR); and Western Pacific Region (WPR).

However, because they have similarly high per capita income rates and low tuberculosis incidence rates, detailed implementation scenarios have not been developed for the countries in the eight TB epidemiological regions.

In developing the scenarios, assumptions were made about the pace of scale-up and the coverage of different activities.

Estimates have been made of TB case detection and treatment outcomes over the next 10 years, as well of TB prevalence, incidence and death rates in relation to the 2015 targets.

These regional scenarios are not implementation plans, though the methodology offers an approach that can be applied at country level.

The next step will be to develop detailed regional and country implementation plans (integrating DOTS Expansion, DOTS-Plus and TB/HIV actions), based on the respective strategic plans.

But the regional scenarios are indicative of what could be achieved, with ambitious but realistic assumptions.

They try to predict what could happen if TB control activities go well, while taking into account general barriers that are difficult to overcome during the ten-year time-span of the Global Plan, or that lie outside the domain of TB control, such as severe health systems constraints.

If there are considerable socioeconomic improvements as a result of action to achieve other MDG targets to which most African countries are committed to though way out of targets, the prospects of reaching the TB control targets earlier - in Africa and Eastern Europe, for example - will be much better.

Similarly, if new preventive, diagnostic or treatment tools become available, they could have dramatic effects on the TB epidemic.