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Geneva, Switzerland, UNAIDS, 2014 Jul.  p. (UNAIDS / JC2656)How do we close the gap between the people moving forward and the people being left behind? This was the question we set out to answer in the UNAIDS Gap report. Similar to the Global report, the goal of the Gap report is to provide the best possible data, but, in addition, to give information and analysis on the people being left behind. A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status. The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV. The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART. By ending the epidemic by 2030, the world would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030.
Geneva, Switzerland, UNAIDS, 2013.  p.The 2013 report on the global AIDS epidemic contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. This report, which follows the endorsement of the 2011 United Nations Political Declaration on HIV and AIDS outlining global targets to achieve by 2015, summarizes progress towards 10 key targets and reviews commitments and future steps. While recognizing significant achievements, UNAIDS warns of slowing progress in meeting some targets. In 2012, there were 35 million people living with HIV (PLHIV), and 2.3 million new infections-a 33 percent decrease from 2001, including significant reductions in new infections among children. More people than ever are on antiretroviral therapy (ART). Twenty-six countries have achieved the global target of halving sexual HIV transmission by 2015, but other countries are not on track to meet this target, hence the need to enhance prevention efforts. Globally, countries have made limited progress in reducing HIV transmission by 50 percent among people who inject drugs. While ART coverage is high, and approaching the target of 15 million PLHIV on treatment, coverage in low- and middle-income countries represented only 34 percent of 28 million eligible PLHIV in 2013. Stigma, discrimination and criminalization towards PLHIV continue; specifically, 60 percent of countries report laws that inhibit access to HIV services by key populations. The results of this report should be used by countries to refocus and maintain their commitments. The authors urged strengthened global commitment to achieve the goal of zero new HIV infections, discrimination, and AIDS-related deaths.
Lancet. 2010 May 22; 375(9728):1757-8.This article describes several urgent actions that are needed to promote rapid scale-up of effective and integrated services for tuberculosis and HIV and to tackle the factors that increase vulnerability and put people at risk of HIV-related tuberculosis. These include: bold national leadership, health system restructuring to foster greater integration of tuberculosis and HIV services that provide routine tuberculosis screening, treatment, and prevention to people living with HIV; and to offer HIV counseling and testing to all patients with signs and symptoms of tuberculosis, decentralized care to ensure improved access, investment in new tools and better use of existing tools, and global leadership from donors, countries of the global south, and key health agencies.
The Global Fund 2010: Innovation and impact. Global Fund-supported programs saved an estimated 4.9 million lives by the end of 2009.
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.The substantial increase in resources dedicated to health through overseas development assistance and other sources during the past years has begun to change the trajectory of AIDS, tuberculosis (TB) and malaria, and more broadly, of the major health problems that low- and middle-income countries have been confronted with. The results and emerging signs of impact presented in this report paint a hopeful and encouraging picture. Ten years ago, virtually no one living with AIDS in low- and middle-income countries was receiving lifesaving antiretroviral therapy (ART), although it had been available since 1996 in high-income countries. At the end of 2008, over 4 million people had gained access to AIDS treatment, representing over 40 percent of those in need. AIDS mortality has since decreased in many high-burden countries. For example, in Ethiopia’s capital, Addis Ababa, the rollout of ART has led to a decline of about 50 percent in adult AIDS deaths over a period of five years.
Fighting the tuberculosis epidemic in the Western Pacific region: current situation and challenges ahead.
Kekkaku. 2010 Jan; 85(1):9-16.INTRODUCTION: Tuberculosis (TB) remains a major public health problem in the Western Pacific Region. More than 20% of the global burden of TB is found in the Region. In 2007, the latest year for which data is available, there were an estimated 1.9 million incident cases (109 per 100,000 population). Four countries (Cambodia, China, the Philippines and Vietnam) account for 93% of the total estimated incident cases in the Region. Every year an estimated 300 thousand persons die due to TB. The Region is host to an estimated 135,000 multi-drug resistant TB cases, most of which can be found in China. TB PREVALENCE AND TB MORTALITY: The Regional Stop TB strategy aims to halve the prevalence and mortality rates of 2000 by 2010. Based on current estimates, the TB prevalence declined with 24% between 2000 and 2007, while TB mortality declined with 19% in the same period. Given the current annual decrease in TB prevalence and mortality, it is unlikely that the Region will achieve the 50% reduction by 2010. CASE FINDING: Approximately 1.4 million new TB cases were notified in the Region in 2007, of which close to 0.7 million smear-positive cases. Cases from China accounted for 70% of the total notified smear-positive cases. The Regional case detection rate was sustained at 78%. Case detection rates in China, the Lao People's Democratic Republic, Mongolia, the Philippines and Vietnam exceeded the 70% target. TREATMENT OUTCOMES: A total of 92% of the 0.7 million new pulmonary smear-positive cases registered for treatment in 2006 were successfully treated. The treatment success rates exceed the 85% target in all countries with a high burden of TB, except Papua New Guinea where it was reported at 73%. MULTIDRUG-RESISTANT TB: In 2007, the proportion of MDR-TB in new TB cases was estimated to be 4%. A total of 135,411 MDR-TB cases was estimated to have occurred in 2007. Based on the overall case management data, 10,231 new patients and 1,596 re-treatment patients were reported with available drug susceptibility testing (DST) results in the Region. Of these, 1% (89/10,231) and 29% (468/1,596) had MDR-TB, respectively. Capacity to detect and treat MDR-TB cases is still very limited in most countries in the Region. Eighteen countries and areas in the Region have conducted drug resistance surveillance (DRS) since 2000, according to the Global Project on Anti-tuberculosis Drug Resistance Surveillance. Among new TB cases, the prevalence of multidrug-resistant TB (MDR-TB) ranged from 0% in Cambodia to 11.1% in the Commonwealth of the Northern Mariana Islands. MDR-TB prevalence among re-treatment cases ranged from 3.1% in Cambodia to 27.5% in Mongolia. In the five countries with a high burden of TB with available data from surveys (Cambodia, China, Mongolia, the Philippines, and Vietnam), MDR-TB prevalence in new cases and re-treatment cases ranged from 0% in Cambodia to 4.9% in China and from 3.1% in Cambodia to 27.5% in Mongolia, respectively. Notably, there were alarming rates of MDR-TB in several provinces in China among both new and retreatment cases. Increasing numbers of MDR-TB cases are reported from Papua New Guinea. TB-HIV CO-INFECTION: The overall estimated prevalence of HIV in new TB cases in 2007 was 2.7%. With 8.0% in 2008 compared to 11.8% in 2003, Cambodia shows a declining prevalence of HIV in new TB cases. There was a significant increase in the use of anti-retroviral therapy (ART) in the Region. However, detailed and complete data as well as strong collaboration in HIV and TB management are needed to be able to closely monitor the use of ART and its impact on TB-HIV co-infection in the Region. CONCLUSION: In spite of the substantial progress made in most countries with a high burden of TB, substantial challenges remain in the Region. The rate of decline in TB prevalence and mortality is too low to reach the 50% reduction goal in 2010. It will be necessary to further increase TB case detection and address the emerging spread of drug-resistant TB. The slow response in the most affected countries in the Region is a cause for concern. Strong commitment by national governments and their partners is needed to sustain and further strengthen the current TB control efforts.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The development and expansion of WHO's DOTS strategy was successful, with 83% of the world's population living in countries or parts of countries covered by this strategy by the end of 2004. Treatment success in the 2003 DOTS cohort of 1.7 million patients was 82% on average, close to the 85% target. Treatment success was below average in the African Region (72%), which can be partly attributed to occurrence of HIV co-infection, and in the European Region (75%), partly due to drug resistance. Drug resistance, specifically multidrug resistance and extensive drug resistance, is a serious threat to public health in all countries, especially in the Russian Federation, where the highest rates of multidrug resistance are presently accompanied by a rapid increase in HIV infection. Based on the experience of the first projects approved by the Green Light Committee, the treatment success of patients with multidrug-resistant tuberculosis (MDR-TB) is lower than that of drug-susceptible cases, but nevertheless reaches 70%. The collaborative effort of different organizations, professionals and communities is needed to address the development and spread of multidrug resistance and extensive drug resistance, which combined with the epidemic of HIV infection is one of the barriers to dealing effectively with TB. This effort should be directed towards facilitating the diagnosis and treatment of TB patients, in particular by improving access to drug susceptibility testing and strengthening treatment delivery by rigorous adherence to DOTS as outlined by the Stop TB Partnership. (author's)
Washington, D.C., Population Reference Bureau [PRB], 2006 Apr. 5 p.As if the global AIDS pandemic alone were not enough, developing countries are beset with converging epidemics of HIV and tuberculosis (TB)--increasing the likelihood of premature death in these countries. Worldwide, 14 million people are coinfected with TB and HIV--70 percent of those in sub-Saharan Africa (see figure for five countries with particularly high coinfection rates). TB is the leading cause of death for those infected with HIV and is implicated in up to one-half of all AIDS deaths. And because HIV compromises the immune system, HIV-positive people are 50 times more likely to develop active TB than those who are HIV-negative. (excerpt)
UN Chronicle. 2005 Jun-Aug; 42(2): p..The battle against tuberculosis (TB) is being successfully fought in most areas of the world, but in Africa the disease has reached alarming proportions with an increasing number of cases and deaths linked to HIV, said the World Health Organization in its WHO Report 2005, Global Tuberculosis Control: Surveillance, Planning, Financing, released on 24 March to coincide with World TB Day. The WHO Report focuses on five principal indicators: incidence, prevalence, deaths, case detection and treatment success. It finds that its prevalence has declined worldwide by more than 20 per cent since 1990 and that incidence rates are falling or stable in all regions except in Africa, where TB rates have tripled since 1990 in countries with high HIV prevalence and continue to rise at 3 to 4 per cent annually. (excerpt)
Global HealthLink. 2001 Mar-Apr; (108):4, 20.A new report jointly issued by six United Nations agencies claims that worsening AIDS, TB and malaria epidemics are not inevitable; the strategies that developing countries have deployed to turn back these diseases and prevent the deaths they cause have been successful. The targets for reducing the toll of these illnesses, set by the world’s leaders at successive summits over the last year, are feasible. What is needed are the funds and systems that will enable widespread implementation of actions that have shown to be effective, the report says. In a joint report issued in December – “Health, a Key to Prosperity: Success Stories in Developing Countries” – the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Joint Programme on AIDS (UNAIDS), the United Nations Population Fund (UNFPA) and the World Bank outline key factors for combating AIDS, tuberculosis, malaria, childhood diseases and maternal and perinatal conditions, even in resource-poor settings. (excerpt)
New York, New York, Global Alliance for TB Drug Development, 2002. 2 p.A Lethal Synergy: While HIV/AIDS has exploded over the last decade, TB has increased 20% rise and today TB kills one out of three AIDS patient worldwide. The two diseases represent a deadly combination, since both are more destructive together than either is alone. HIV infection is the most potent risk factor for converting latent TB into active transmissible TB - accelerating the spread of the disease - while TB bacteria help accelerate the progress of the AIDS infection in the patient. Today TB is the leading cause of death in persons who are HIV positive. (excerpt)
[Unpublished] 2000 Apr  p. (Fact Sheet No. 104)Tuberculosis (TB), which is an air-borne contagious disease, kills 2 million people each year. It is estimated that between the years 2000 and 2020, nearly 1 billion people will be newly infected, 200 million people will get sick, and 35 million will die from TB if control is not further strengthened. The worsening impact of this disease is further compounded by the breakdown in health services, the spread of HIV/AIDS, and the emergency of multidrug- resistant TB. To this effect, the WHO took an unprecedented step to declare TB a global emergency in 1993. The WHO recommended a treatment strategy known as the Directly Observed Treatment Services (DOTS). The DOTS combine five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems, and use of highly efficacious regimes with direct observation of treatment. The WHO targets are to detect 70% of new infectious TB cases and to cure 85% of those detected. In 1998, six countries had achieved this target.
1999 World TB Day: WHO TB report shows global response to epidemic inadequate. WHO Director-General calls for political commitment to Stop TB. "We must act now or multi-drug resistant TB will thrive," warns Dr. Gro Harlem Brundtland. Press release.
Geneva, Switzerland, WHO, 1999 Mar 23. 3 p. (Press Release WHO/16)Annually, there are 8 million new cases of tuberculosis (TB) and multi-drug resistant TB is on the rise. According to the 1999 WHO Global TB Report, the spread of TB and the emergence of multi-drug resistance can be stopped through the WHO recommended Direct Observation Treatment, Short-course. But still, only 16% of the world's infectious TB sufferers receive the TB treatment recommended by WHO. In this regard, WHO has launched the Stop TB Initiative in partnership with the World Bank, the Centers for Disease Control and Prevention and a coalition of nongovernmental organizations working to stop the spread of TB. The Initiative aims to accelerate TB control by expanding the global coalition of partners beyond the health sector; place TB higher on international political and health agendas; and significantly increase investment in TB control. The WHO Director-General Dr. Gro Harlem Brundtland, calls for political commitment to stop TB before multi-drug resistant TB will thrive.
Journal of the Indian Medical Association. 2000 Mar; 98(3):100-2.The modern era of tuberculosis (TB) began in the mid-1980s. In 1993, WHO took the unique step of declaring TB to be a world emergency. Despite this intervention it is estimated that deaths from TB will increase from 3 million a year currently to 5 million by the year 2050. There are four principal reasons: world population's increase, co-infection with HIV/AIDS, poverty and program decline. Other causes contributing to the global epidemic are multidrug-resistant TB, immigration, and indifference. The practical solution must concentrate on the completed correct treatment of the disease particularly in those who are sputum smear positive. For this reason WHO is vigorously promoting the Direct Observed Therapy Short course (DOTS) campaign. Doctors treating TB should ideally be part of the public health system. They should have access to first class bacteriological services, good quality of drugs, and should make sure that the patient receives the drugs under supervision. Though the reasons for increasing TB are multifactorial it is within the capability of the world to re-exert control providing that the political will is present. (author's)
Geneva, Switzerland, World Health Organization [WHO], Global TB Programme, 1998. , 52 p. (WHO/TB/98.247)This document presents the WHO Report on the global tuberculosis (TB) epidemic in 1998. The success of the Directly Observed Treatment, Short-course (DOTS) for TB has been proven in diverse areas of the globe such as China, Peru, and Bangladesh. However, a larger number of people is still dying of TB today than in any period in history, particularly in countries where DOTS was not implemented. TB epidemic is a global problem that demands a global solution. The Global TB Program aims to significantly reduce the TB sickness and deaths in the world through global monitoring and surveillance, country support, research and new tool development, advocacy and social mobilization, and new initiatives. The greatest challenge in controlling TB is political rather than medical. This document also presents data available on case notifications (1996) and treatment results (1995). Estimated number of TB cases are derived from the 1990 incidence rates published in the World Bank's World Development Report 1993 and recalculated based on the 1996 population and reported TB cases.
IMPO NEWSLETTER. 1998 Dec; 3.Worldwide, 2-3 million people die annually from tuberculosis (TB). Unless concerted efforts are taken in Asia, the TB epidemic will continue to worsen, jeopardizing global control efforts. At a 4-day conference in Bangkok of more than 1500 lung disease experts, Dr. Heidi Larson, a senior World Health Organization official, noted that the economic crisis in southeast Asia has increased the risks of TB spreading throughout the region. The danger of a major resurgence of TB has been made worse by drug resistance developed as a result of haphazard treatment of the condition in poor countries. Malnutrition and generally worsening health problems caused by the economic crisis have increased the likelihood of people developing active TB because they have weakened immune systems. Interruptions of drug supplies also broaden the scope for the development of drug-resistant TB. The World Health Organization has identified China, India, and Indonesia as the countries which have experienced the most dramatic increases in cases of active TB. TB can be cured on a large scale, but both national and international political commitment are needed.
Lancet. 1997 Dec 6; 350(9091):1689.Experts from almost 60 medical schools in India have called for phased expansion of India's Revised National Tuberculosis Control Programme (RNTCP) as "perhaps the only chance of controlling the emerging TB epidemic in India during this generation." The RNTCP, which is based on the Directly Observed Treatment, Short Course of the World Health Organization (WHO), was begun in 1993. In a pilot project conducted in 20 sites for 4 years, 8 out of 10 patients were cured; in previous programs, 3 out of 10 were cured. The new goal of the program is to cover the total population of 300 million over the next 3 years. The Medical Officer (TB) of WHO in Delhi, believes "the RNTCP could save more lives in India than any other public health intervention in the next decade." Almost 2 out of 5 TB cases globally occur in India; 50% of all adults there are infected. 2.2 million new cases occur there annually and the total annual number of cases in India is 14 million; 3.5 million of these people are highly infectious. 2 people/minute in India become sputum-positive, almost 1 patient/minute dies of TB, and more than 1000 people die of the disease daily. The HIV epidemic, particularly with reference to multidrug-resistant TB (MDRTB), is also of concern. The current situation regarding MDRTB is unknown because of a lack of good surveillance; WHO has designed a new strategy to meet this need. The WHO Medical Officer (TB) believes that MDRTB must be prevented from emerging and that a poor TB control program, even with unlimited resources, will create MDRTB cases more quickly than they can be cured.
JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE. 1995 Jun; 1(5):34.Tuberculosis (TB) is the leading killer, globally, of persons who are infected with human immunodeficiency virus (HIV); however, few countries are prepared to deal with this. In response, research experts on acquired immunodeficiency syndrome (AIDS) and TB met the first week of June to identify the best way to improve TB control in areas where HIV is prevalent or increasing. Dr. Arata Kochi, Director of the Global TB Program of the World Health Organization, warned that TB would kill almost one-third of those infected with HIV and would infect many of their contacts, both negative and positive for the virus, as the incidence of HIV rose in Asia. By the end of the decade, around one-third of all deaths among HIV-positive people will result from TB, according to Global TB Program estimates. In Abidjan, 32% of AIDS cases were considered to have died from TB. HIV is spreading more rapidly in Asia, where TB is more widespread than in Africa. Anthony Harries, a physician at Queen Elizabeth Central Hospital in Malawi, states that the co-epidemic complicates efforts to care for AIDS patients and to identify and treat TB patients. While caseloads are increasing, health workers are faced with a shortage of manpower and funds and a lack of appropriate technology. The meeting was convened by the Global Tuberculosis Program.
AIDS WEEKLY PLUS. 1995 Nov 20-27; 24-5.One-third of the world's population is infected with the tuberculosis (TB) bacillus. Like the common cold, TB is spread through the air and by relatively casual contact. Migration, international travel, and tourism are therefore increasingly allowing TB to penetrate borders. An untreated person with active TB will typically infect 10-15 other people over the course of one year. Only 5-10% of people infected with TB, however, actually become sick or infectious themselves. Nonetheless, among infectious diseases, TB is the leading killer of adults in the world today, currently killing more adults annually than AIDS, malaria, and tropical diseases combined, and almost 300,000 children. The disease accounts for more than 25% of all preventable adult deaths in developing countries. An estimated 300 million people will be infected during the next decade, 90 million people will develop the disease, and 30 million people will die from it. The global resurgence of TB is being accelerated by the spread of HIV, with TB already the leading cause of death among HIV-seropositive individuals. TB, together with AIDS, has overwhelmed health services and devastated urban populations in parts of Africa. The emergence of drug-resistant strains of TB is of particular concern to the World Health Organization (WHO), surely a factor in WHO's April 1993 declaration of TB to be a global emergency, the first declaration of its kind in WHO history. There is no cure for some multidrug-resistant strains of TB, and there is concern that they may spread rapidly around the world. Curing TB cases is the most cost-effective way to check the spread of TB in communities with high incidence of the infection, and the best curative method for TB is the Directly Observed Treatment approach in which health workers watch patients take each dose of medication throughout the full course of the treatment regimen.
AIDS ASIA. 1995 May-Jun; 2(3):9.The World Health Organization (WHO) and the Japanese Anti-Tuberculosis Association estimate that tuberculosis (TB) will be responsible for more than 20 million premature deaths in Asia because governments worldwide have stopped fighting TB. About 66% of all TB cases in the world are in Asia. HIV infection is spreading more rapidly in Asia than anywhere else in the world. In the next 10 years, TB and AIDS will probably be responsible for the deaths of more Asians than the combined populations of the cities of Singapore, Beijing, Yokohama, and Tokyo. People with HIV infection are 30 times more likely to develop TB than people with no HIV infection. In fact, an HIV-positive person has a 10% chance of developing TB each year, while an HIV-negative person has a 10% chance of developing TB in his/her lifetime. Just breathing the same air as people infected with TB places the immuno-comprised person at risk of TB. A few weeks after beginning TB treatment, most TB patients, regardless of HIV status, are no longer contagious. Yet, governments' unwillingness to fight TB results in less than 50% of all TB cases being cured of TB. Some poor countries (Tanzania, Mozambique, China, and Peru) have invested in effective TB control programs, resulting in a cure rate as high as 90%. WHO estimates that annual expenditures geared towards HIV control in developing countries need to increase between $1500 million and $2900 million. They must increase between $100 million and $150 million for TB control activities. Yet, funding for WHO's Global Programme on AIDS is decreasing and its TB program operated on $7 million in 1994. The Japanese government provides more foreign aid to WHO's TB Programme than any other developed country. As of 1992, Japan had about 11,000 HIV-infected persons compared to about 30 million persons with TB. More than 32,000 Japanese will probably die from TB during the 1990s.