DOTS, the cornerstone of WHO’s Stop TB Strategy, is available for 97% of the world’s population. Some 155 countries have adopted national strategic plans for TB control, including all 22 high-burden countries. The Global Plan’s treatment success milestone for 2008 of 83% has been surpassed — treatment success is now up to 85% worldwide.
Testing for drug resistance has increased almost threefold, and the proportion of people diagnosed with MDR-TB approved by the Green Light Committee increased from 7.3% in 2006 to 48% in 2008. Many countries have increased national collaborative activities to address HIV among people diagnosed with TB. Between 2005 and 2007 the percentage of TB patients tested for HIV in African countries with a high prevalence of HIV rose from 14% to 41%.
On the research front, nine vaccine candidates are in Phase I clinical trials, and by end 2008 three had entered Phase II trials. These are impressive gains, since the Plan calls for at least 20 vaccine candidates in Phase I trials by 2015. In diagnosis, new techniques have been introduced to referral laboratories that produce results in a few hours instead of weeks. On treatment, clinical trials by Stop TB partners on gatifloaxacin and moxifloaxacin may provide evidence for a shortened regimen for treating TB.
Despite these strides many obstacles remain. The detection of new smear-positive TB cases has slowed, suggesting that the 2010 milestone of a 78% detection rate will not be achieved unless countries take rapid and innovative actions. The great majority of people with multidrug-resistant TB are still not receiving effective treatment; and countries have not made sufficient progress in screening HIV-positive people for TB or increasing the numbers of people on preventive therapy.
Research efforts need to accelerate to develop and evaluate tests to detect active TB at the first point of care; to develop a robust pipeline of new drug candidates; and to reach the goal of a new vaccine by 2015.
Funding remains the most serious challenge. From 2006-2008, the financing needs for funding TB control worldwide was short by $US 1 billion per year. The gap for research and development was approximately US$ 0.5 billion for 2007.