HEALTH: Waging the Battle against Tuberculosis

Tuberculosis (TB) is an ancient disease that has plagued humanity for millennia. However, TB is curable with treatment - meaning this terrible disease can be stopped. Worldwide, the number of people getting sick from TB each year is dropping, and the number of people dying from the disease fell to its lowest level in a decade. Still, there were an estimated 8.9 million cases and 1.4 million deaths in 2010. For this reason, TB is a top-priority target for governments, donors, the private sector, faith and community-based groups all over the world. U.S. President Barack Obama and Secretary of State Hillary Clinton have prioritised global health and human welfare. On World TB Day, observed each year on March 24, the United States reaffirms its commitment to working with our partners to fight this deadly disease. We support programmes that are saving lives and fostering a more secure world, focusing our efforts in countries where the burden of the disease is highest. The United States is the largest contributor to the Global Fund to Fight AIDS, TB, and Malaria and across our federal government from the Centers for Disease Control and Prevention (CDC) to the National Institutes of Health (NIH) to the U.S. Agency for International Development (USAID), and via the Global Health Initiative (GHI) and the President’s Emergency Plan for AIDS Relief (PEPFAR) − we have made the fight against TB a priority. The United States works together with national TB control programmes in 41 countries with resources and personnel to find and treat TB earlier. These joint efforts prevent the spread of the disease and the development of drug resistance. USAID and CDC also support research to improve existing approaches to TB control and develop new tools and facilitate their uptake within countries.As a result, in 2011, 3.8 million TB cases were detected in countries that partner with USAID and CDC -- a 51 percent increase since 2000. Over the past year, millions of lives were saved and tens of millions of additional cases of TB were averted through increased disease surveillance, earlier TB detection and treatment.The key to TB control is active detection and treatment compliance. Rwanda has made great strides in this regard. From 2010 to 2011, suspected TB cases increased from 70,000 in 2010 to 130,000 in 2011, with over 7,000 cases of TB detected. The vast majority of these were identified and treated by directly observed therapy (DOT) at the community level by a network of 60,000 community health workers (CHWs) throughout the country.The emergence of multi-drug resistant TB (MDR-TB) is a major international health problem and Rwanda is responding to this challenge by active detection, increasing access to second line treatment and ensuring treatment compliance. Rwanda has a national “Stop TB” strategy which focuses on expanding high quality DOT, addressing the challenges of HIV/TB co-infection and MDR-TB, contributing to health system strengthening, engaging all care providers across the health spectrum from CHWs, traditional healers, to doctors at reference hospitals in TB diagnosis, empowering people and communities with TB, and enabling and promoting research. All of this ensures that Rwanda is on the path to cut in half the incidence of TB in this country by 2015.We know from past experience that continued vigilance is essential to maintaining gains and reaching our goals. And if the global health community can harness science, technology and innovation for the poorest communities in the world, we can leave an unparalleled legacy in global health in this next decade. The author is the Chargé d’Affaires at the U.S. Embassy in Kigali