AFRO-NETS> HIV causing TB cases to double in Africa

[P Heitkamp <heitkampp@who.ch>]

HIV causing TB cases to double in Africa
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Joint UNAIDS/WHO Press Release/21
23 April 2001 

HIV CAUSING TUBERCULOSIS CASES TO DOUBLE IN AFRICA

The World Health Organization (WHO) and the Joint United Nations Pro-
gramme on HIV/AIDS (UNAIDS) today warned that Tuberculosis (TB) cases 
in Africa will likely double over the next decade as a consequence of 
the increased spread of HIV and the under-funding of strategies ef-
fective in curing TB.

Evidence being presented this week at the Organization of African 
Unity Summit on HIV/AIDS, TB and Other Infectious Diseases in Abuja, 
Nigeria, will show that TB cases are increasing 10% per year in Af-
rica because of HIV. There were nearly two million new TB cases in 
Africa in 1999, with two-thirds of those also infected with HIV. Ex-
perts estimate that the number of TB cases in Africa will reach 3.3 
million by 2005 and surpass 4 million shortly thereafter.

"There is an urgent need to address TB and HIV together," said Dr Pe-
ter Piot, Executive Director of UNAIDS. "Reducing transmission of HIV 
will reduce the epidemic of TB. Joint TB/HIV activities are needed to 
decrease the burden of HIV-related TB."

"Tuberculosis is a leading killer of people living with HIV/AIDS," 
said Dr Gro Harlem Brundtland, Director-General of WHO. "Up to 50% of 
people with HIV in sub-Saharan Africa develop TB. This is one of the 
reasons why the control of TB and HIV in Africa is so interdepend-
ent."

Another reason is that people with HIV - just like people who are 
sick with TB - can easily develop drug-resistant forms of these in-
fections unless their medications are provided under some form of su-
pervision. 

Care and support for TB patients is provided through a strategy known 
as DOTS (the internationally recommended TB control strategy). This 
strategy - first developed in Tanzania in the 1980s - makes maximum 
use of community health workers and volunteers to provide support to 
patients and to ensure that they are taking their medication until 
they are fully cured. Increasing the availability of DOTS in Africa 
is considered a key not only for curing TB cases but also for orga-
nizing health infrastructure in communities for the future provision 
of anti-retroviral drugs required for treating HIV.

"Experience in increasing access to TB drugs will make an enormous 
contribution to HIV/AIDS care and support," said Dr Jong-Wook Lee, 
Director of Stop TB Department in WHO. "The DOTS strategy provides an 
excellent model for increasing access to anti-retrovirals."

A key principle of DOTS is the use of effective standardized treat-
ment regimens, provided in a supportive and patient-friendly environ-
ment, with direct observation of treatment to maximize adherence and 
reduce drug resistance. Currently, over 300 000 people in Africa are 
being treated for tuberculosis using the DOTS strategy.

Worldwide, nearly 900 000 people are treated through DOTS services. 
Their cure rates are two to three times higher compared to patients 
without access to the DOTS strategy. Drug resistance is three times 
lower in DOTS projects than in health services not providing DOTS.

WHO and UNAIDS recommend rapid expansion of DOTS services. There is a 
need to strengthen national and local infrastructures and community-
based care approaches to tackle TB and HIV. 

The strong increase in TB cases that have occurred in many sub-
Saharan African countries has often outstripped their capacity to 
maintain adequate supplies of TB drugs. The Stop TB global partner-
ship, hosted by WHO, recently launched the Global TB Drug Facility, a 
new initiative to rapidly expand DOTS by increasing access to high 
quality TB drugs.

TB germs are transmitted through the air, spreading from person to 
person through coughing, sneezing or even talking. As the disease 
progresses, it is characterized by fever, weight loss and violent 
coughing which effectively disperses the TB germs to infect surround-
ing individuals. Nearly 2 billion people - one-third of the world's 
population - are currently infected with the TB germ. Between 5% to 
10% of these people will eventually become sick with TB. However, 
people infected with both the TB germ and HIV are 30 times more 
likely to become sick with TB than people infected with the TB germ 
only.

For further information, visit the 
Stop TB Website <http://www.stoptb.org>
WHO/Tuberculosis website <http://www.who.int/gtb>
UNAIDS Home Page <http://www.unaids.org>

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