WHO report 2005: TB linked to HIV at alarming levels in Africa.

• Author: Reinhardt, Erika

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.

Case notifications from African countries show patterns that are likely to be associated with HIV infection. Women aged 15 to 24 years make up a great proportion of TB cases in countries with higher rates of HIV infection. HIV prevalence tends to be more in women than men in the same age range. The difference between the sexes is bigger in areas where HIV-infection rates are higher. The average age is typically lower for smear-positive TB cases where HIV-infection rates are higher, especially for women, a sign that younger people are more likely to be infected with HIV.

The report also states that those who are HIV-positive can easily be screened for tuberculosis and that TB patients can be offered an HIV test. This means that TB programmes can make a major contribution in identifying eligible candidates for antiretroviral (AVR) treatment. "Evidence in this report provides real optimism that TB is beatable, but it is also a clear warning", said WHO Director-General Dr. Lee Jong-wook. "As Nelson Mandela has said, 'we can't fight AIDS unless we do much more to fight TB', and it is time to match his words with urgent action in Africa on the two epidemics together."

There has been major progress in China and India, which account for one third of the global TB burden. Both countries are leading the accelerated response to control the disease by rapidly scaling up the internationally recommended strategy for TB control (DOTS). As a result, the number of cases treated under DOTS rose 8 per cent in 2003 compared to the previous year. Other countries, including Indonesia and the Philippines, are showing similar progress. In addition, the Americas, Eastern...