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The Global Fund and Partners: Fighting Tuberculosis across the Globe

Tuberculosis now ranks alongside HIV/AIDS as the leading cause of death globally.[1] The disease is triggered by various strains of mycobacteria, which usually affect the lungs, though it can also affect other parts of the body. Highly contagious, tuberculosis is an airborne disease predominately spread by coughing or sneezing. It is estimated that one-third of the world’s population has latent tuberculosis, meaning they have been infected with the bacteria but it remains inactive. These individuals do not feel sick, show symptoms or spread the bacteria to others; however, they are still at risk of developing active tuberculosis. Without proper treatment, about 10 percent of this population will develop the disease.[1]

Global investments to fight tuberculosis have led to a drop in global mortality and prevalence rates by 47 percent and 42 percent respectively since 1990.[1] Access to care also has expanded significantly; between 2000 and 2014, 43 million lives were saved globally.[1] Around 80 percent of tuberculosis cases today occur in 16 of the 22 high-burden countries. [1] In 2014, there were an estimated 9.6 million new cases and 1.5 million deaths from the disease.[1] Approximately 86 percent of global tuberculosis cases occurred in African, Southeast Asian and Western Pacific regions; India alone accounted for one-third of these cases.[1]

Global Investments in Tuberculosis

The Global Fund is the largest provider of international donor funding for the fight against tuberculosis, providing more than three-quarters of all international financing and cumulatively approving more than $5.6 billion to fight the disease since 2002.[2] The Global Fund partners with organizations within the U.S. government such as the Centers for Disease Control and the U.S. Agency for International Development to provide in-country assistance for tuberculosis programs.

Successes in the Fight against Tuberculosis

Globally, between 2000 and 2014, an estimated 43 million lives were saved by tuberculosis prevention, diagnosis and treatment efforts.[1]

As of the end of 2015, through Global Fund resources, 15.1 million cases of tuberculosis had been treated, and 267,000 people were receiving treatment for multidrug-resistant tuberculosis.[2]

In Africa, where the HIV/tuberculosis co- infection rate is highest, 79 percent of tuberculosis patients had documented HIV test results in 2015 — up from 69 percent in 2011.[1]

Globally the treatment success rate for people newly diagnosed with TB was 86 percent in 2013.[1]

Strategically Fighting Tuberculosis

As the disease is both curable and preventable, the greatest challenge is reaching those who are infected. Every year about 3 million people with active tuberculosis are not diagnosed and continue to spread the disease. [3] The failure to detect and treat these missing 3 million people has impeded the control of tuberculosis. In addition, 3.3 percent of new TB cases and 20 percent of patients previously treated for tuberculosis have multi-drug resistant tuberculosis (MDR-TB), due in large part to incomplete or insufficient treatment.[1] Drug-resistant forms of tuberculosis are an added burden on health systems and patients, given that they are more difficult and expensive to treat. Globally, an estimated 300,000 people developed cases of MDR-TB in 2014, more than half of which were in India, China and the Russian Federation.[1]

Additionally, the co-infection of HIV/AIDS and tuberculosis is a serious concern. People living with HIV are 26 to 31 times more likely to become sick with tuberculosis than people without HIV.[1] In fact, the HIV epidemic has fueled the number of tuberculosis cases during the last three decades. In 2014, an estimated 1.2 million (or 12 percent) of the 9.6 million people who developed tuberculosis were HIV-positive. About 74 percent of these cases were in the African region.[1]

New Tools for Treatment and Prevention

At present, the development of new diagnostics, medicines and vaccines for tuberculosis does not keep pace with the development of drug-resistant tuberculosis strains. The current tuberculosis vaccine, developed more than 80 years ago, prevents severe forms of childhood tuberculosis but does not protect against the most prevalent form of the disease.[4] Treatment of drug-sensitive tuberculosis typically takes six months with first-line antibiotics, while MDR-TB requires treatment with second-line medicines for at least 20 months.[5] Though access to treatment is an issue, a far greater challenge is the need for diagnosis.

Recently, an innovative test that detects the disease and resistance to Rifampicin in 90 minutes was endorsed by the World Health Organization and has been increasingly adopted worldwide; it plays a pivotal role in identifying MDR-TB cases.[5] In addition, there are 8 new or repurposed drugs in the advanced stages of clinical development.[1] For the first time in six years, a tuberculosis drug candidate is in Phase 1 testing.[1] In late 2012, the U.S. Food and Drug Administration approved Bedaquiline as part of a combination therapy to treat adults with MDR-TB.[6] By the end of 2014, 43 countries reported having used Bedaquiline to treat patients as part of efforts to expand access to treatment for MDR-TB.[1] Researchers have also made significant progress in vaccine development and there are currently fifteen vaccine candidates being evaluated in clinical trials.[1]

Continuing the Fight against Tuberculosis

The full implementation of currently available tools, coupled with the introduction of new diagnostics and medicines, provide an opportunity for meaningful reduction in disease burden over the next decade. The Global Fund and its partners are fully committed to fighting and defeating tuberculosis, but the effective scale up, sustainability and success of programs rely on strong financial and political commitments from the international community.

[1] WHO Global TB Report 2015
[2] The Global Fund Results
[3] The Lancet: Finding the missing 3 million
[4] WHO Biologicals
[5] UNITAIDS Tuberculosis Medicines Technology and Market Landscape
[6] FDA News Release