News | March 19, 2008

WHO Says Drug-Resistant TB Cases Increasing, Diagnosis Slowing

March 20, 2008 - Drug-resistant tuberculosis is rising to record levels, according to the World Health Organization (WHO), which released a report this week, which that also said the pace in controlling the tuberculosis (TB) epidemic slowed in 2006, the most recent year for which data was available.

Multidrug-resistant tuberculosis (MDR-TB) was reported by WHO last month to have reached the highest levels ever recorded. To date, however, WHO says the response to this epidemic has been inadequate. Given limited laboratory and treatment capacity, countries project they will provide treatment only to about 10 percent of people with MDR-TB worldwide in 2008.

The new report also documents a slowdown in progress on diagnosing people with TB. Between 2001 and 2005, the average rate at which new TB cases were detected was increasing by 6 percent per year. Between 2005 and 2006 that rate of increase was cut in half, to 3 percent.

WHO said the reason for this slowing of progress is that some national programs were making rapid strides during the previous five years, but were unable to continue at the same pace in 2006. In most African countries WHO said there was no increase in the detection of TB cases through national programs. Other studies have also shown many patients are treated by private care providers, and by nongovernmental, faith-based and community organizations, which escape detection by the public programs.

"We've entered a new era," said Dr. Margaret Chan, WHO director-general. "To make progress, firstly public programs must be further strengthened. Secondly, we need to fully tap the potential of other service providers. Enlisting these other providers, working in partnership with national programs, will markedly increase diagnosis and treatment for people in need."

This is the 12th annual WHO report on global TB control, and is based on data given to WHO by 202 countries and territories. There were 9.2 million new cases of TB in 2006, including 700,000 cases among people living with HIV, and 500,000 cases of multi-drug resistant TB (MDR-TB). An estimated 1.5 million people died from TB in 2006. In addition, another 200,000 people with HIV died from HIV-associated TB.

In addition to MDR-TB, WHO said the second threat to continued progress is the lethal combination of TB and HIV, which is fuelling the TB epidemic in many parts of the world, especially Africa. Although TB/HIV remains a massive challenge, some countries are making strides against the co-epidemic. Almost 700,000 TB patients were tested for HIV in 2006, up from 22,000 in 2002. This is a sign of progress, but still far from the 2006 target of 1.6 million set by the Global Plan to Stop TB 2006-2015. The three African countries achieving the highest HIV testing rates in TB care settings in 2006 were Rwanda (76 percent), Malawi (64 percent) and Kenya (60 percent).

The report also documents a shortage in funding. Despite an increase in resources, especially from the Global Fund and some middle-income countries, TB budgets are projected to remain flat in 2008 in almost all of the countries most heavily burdened by the disease. Ninety countries in which 91 percent of the world's TB cases occur provided complete financial data for the report. To meet the 2008 targets of the Global Plan to Stop TB, the funding shortfall for these 90 countries is about $1 billion.

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