Approximately two billion people-one third of the world's population-are infected with the mycobacteria that cause tuberculosis (TB). Though healthy individuals may never develop active TB, an estimated two million people with compromised immune systems still die of this air-borne infectious disease each year- This in spite of the fact that a cost-effective cure for TB was developed more than fifty years ago.

To date, the Global Fund has approved 81 grants in 69 countries for programs to combat TB and TB/HIV co-infection. These grants are worth up to US$1.2 billion over the five-year lifespan of the grants. In collaboration with the Stop TB Partnership, national TB programs and other partners around the world, the Global Fund to Fight AIDS, Tuberculosis and Malaria is working to achieve the global targets set by the World Health Assembly as goals to be accomplished by 2005: to detect 70% of infectious cases of TB, and to cure 85% of detected cases.

The Impact of TB

TB flourishes particularly well in poor communities, where individuals with weakened immune systems (those who are sick, malnourished or living with HIV/AIDS for example) are more likely to develop active TB. Higher numbers of individuals with active TB in a community contribute to higher infection rates, and a vicious cycle ensues. As a result, eighty percent of the TB disease burden worldwide is concentrated in 22 of the world’s 192 countries.

The Solution - and the Challenge

DOTS, the internationally approved treatment strategy for TB, has been found to achieve a 95% cure rate, even in the poorest countries, and the cost of a six to eight month course of treatment has been brought down to US$10 per patient. Based on these factors, the World Bank has ranked DOTS as one of the most effective of all world health interventions to date. The World Health Organization estimates that most regions of the world are on track to halve TB cases and deaths by 2015, if DOTS treatment and other effective TB treatment services continue to be expanded.

Nonetheless, initiatives to combat TB face new challenges in the rising incidence of drug- resistant TB, and the escalating HIV/AIDS pandemic, for which TB represents an often deadly opportunistic infection. TB has become a leading cause of death among people living with HIV, accounting for 13% of AIDS deaths worldwide. The growth of the HIV/AIDS pandemic has had a parallel effect on TB caseloads, as individuals who are HIV-positive and infected with the Tuberculosis bacteria are many times more likely to become sick with active TB.

Drug-resistant strains of TB present a similar threat to efforts to control Tuberculosis, as new strains resistant to all major anti-TB drugs have emerged. Drug-resistance occurs when patients do not take their medicines regularly or complete their course of treatment. Wrongly prescribed treatment regimens and unreliable drug supplies also contribute to the emergence of drug-resistant TB. While generally treatable, drug-resistant TB requires extensive chemotherapy (up to two years of treatment) that may be prohibitively expensive (often more than 100 times the cost of DOTS treatment, for example), and is also more toxic to patients. In addition, these treatment regimens show a much lower success rate than the DOTS treatment strategy.

In Africa, Eastern Europe and Central Asia, drug resistant strains of TB and TB/HIV co-infection threaten to undo progress made against the disease. Without a significant expansion of outreach and resources, these regions will not see the gains made worldwide in the fight to control Tuberculosis.