World Tuberculosis Day 2014 - Reach The Three Million

World Tuberculosis Day - 24 March 2014

The "missed" 3 million

In 2014, the slogan for World Tuberculosis Day is "Reach the 3 million".

TB is curable, but current efforts to find, treat and cure everyone who gets ill with the disease are not sufficient. Of the 9 million people a year who get sick with TB, a third of them are "missed" by health systems. Many of these 3 million people live in the world’s poorest, most vulnerable communities or are among marginalized populations such as migrant workers, refugees and internally displaced persons, prisoners, indigenous peoples, ethnic minorities and drug users.

WHO and the Stop TB Partnership, hosted at WHO, are together promoting World TB Day. World TB Day provides the opportunity for affected persons and the communities in which they live, governments civil society organizations, health-care providers, and international partners to call for further action to reach the 3 million. All partners can help take forward innovative approaches to ensure that everyone suffering from TB has access to TB diagnosis, treatment and cure.

The burden of tuberculosis

World TB Day is an opportunity to raise awareness about the burden of tuberculosis (TB) worldwide and the status of TB prevention and control efforts. The Day is also an occasion to mobilize political and social commitment for further progress.

Progress towards global targets for reductions in TB cases and deaths in recent years has been impressive: TB mortality has fallen over 45% worldwide since 1990, and incidence is declining. New TB tools such as rapid diagnostics are helping transform response to the disease and new life-saving drugs are being introduced.

But the global burden remains huge and significant challenges persist.

In 2012, there were an estimated 8.6 million new cases of TB and 1.3 million people died from TB.

Over 95% of TB deaths occur in low- and middle-income countries. Poor communities and vulnerable groups are most affected, but this airborne disease is a risk to all.

TB is among the top 3 causes of death for women aged 15 to 44.

There were an estimated 500 000 cases and 74 000 deaths among children in 2012.

Challenges

Around 3 million people (equal to 1 in 3 people falling ill with TB) are currently being ‘missed’ by health systems.

There is slow progress in tackling multi-drug resistant TB (MDR-TB): 3 out of 4 MDR-TB cases still remain without a diagnosis, and around 16 000 MDR-TB cases reported to WHO in 2012 were not put on treatment.

Provision of antiretroviral therapy (ART) for TB patients known to be living with HIV needs to increase to meet WHO’s recommendation that all TB patients living with HIV promptly receive ART.

In India

Of the approximately 3 million people who get sick with TB every year in the WHO South-East Asia Region, a third do not get the TB services. On World TB Day, WHO is urging countries to find, treat and cure the “missing” 1 million who do not get TB services, in order to accelerate progress towards zero TB deaths, infections, suffering and stigma.

“Drugs alone cannot beat TB in the community. TB is a condition strongly influenced by low nutrition, poverty, social stigma, environment, rapid urbanization, and large population displacement in many countries, and these are the factors that result in so many unreported cases. “We have made substantial progress in TB, but unless we address the social, economic and behavioural determinants that impact TB, our fight will not be over.”

The Region accounts for 39% of the global burden of TB in terms of TB incidence. India alone account for 26% of the world’s TB cases. It is estimated that about 3.4 million new cases of TB continue occur each year and about 450 000 people died of this disease in 2012; most of these in five countries, namely, Bangladesh, India, Indonesia, Myanmar and Thailand.

WHO South-East Asia Region is on track to achieve the global target of 50% reduction in death rates due to TB (compared with 1990) by 2015. People’s access to TB care has expanded substantially in the Region, and since 2011 all Member States have continued to have at least 89% treatment success rates. Almost 22 million TB patients have been treated in the past 10 years.

Due to good implementation of the directly observed treatment, short course (DOTS), multidrug resistance among newly detected TB cases is relatively low in the Region. Laboratory networks have been strengthened in all countries to better detect TB infections.

A comprehensive package of TB –HIV interventions is now available to over 1500 million people in the Region. Intensified case-finding is steadily increasing at integrated TB–HIV counselling and testing and care centres. India, Indonesia, Myanmar and Thailand — the high-burden countries in terms of HIV — have strong and unique TB–HIV referral and integrated management mechanisms.

However, to reach the hard-to-reach populations in need of TB care, the primary-health care approach is seen as the most feasible way. Public–private initiatives have resulted in increased notification of cases. Community-based TB services are expanding, and have demonstrated cost–effectiveness, higher utilization of services, and better outcomes. Social support that entitles TB patients to community-based poverty alleviation schemes positively impacts treatment access as it brings down social and economic barriers.

TB is curable. With the focus on increased community awareness and community engagement in tuberculosis, reaching the million in need of treatment will be a major step forward in the ultimate goal of eliminating TB.