The world’s biggest infectious killer – tuberculosis (TB) – is also the most common cause of HIV-related deaths. According to the World Health Organisation (WHO), HIV-infected people are up to 31 times more likely to develop TB than those without HIV, because their immune systems are weaker.
Globally, about one out of three people are infected with the TB bacterium, according to the WHO, but this “latent” form of the disease only progresses to active TB disease in about 10% of cases. In most people, the bacterium remains dormant for life. In South Africa up to 80% of the population has latent TB.
South Africa is also the country with the highest number of HIV-infected people in the world – a report released by the Joint United Nations Programme on HIV and Aids last week, estimates the number of people with HIV in the country at 6.8 million.
According to the Stop TB partnership, of which Health Minister Aaron Motsoaledi is the co-chair, 60% to 70% of TB patients in South Africa are also HIV-positive.
Because of the drastic impact of TB-HIV co-infection in the country, Motsoaledi instructed the South African National Aids Council two years ago to make TB part of its agenda. “So far, we’ve outlined who is the most vulnerable to TB – prisoners, miners and communities close to mines – and we’re starting to address them first,” Motsoaledi said at a press conference in Cape Town on Monday.
Stop TB estimates, that if the world continues to fight TB at its current rate, it will take 180 years to eradicate the disease.
While TB has had relatively few “political champions”, 635 MPs from 101 countries around the world have joined the Global TB Caucus and signed a declaration in which they commit to eradicate TB by 2035. Fifty of those MPs will be attending the Union World Conference on Lung Health in Cape Town, which starts on Wednesday.
The MPs are committing to an initial five-year plan (2016-2020) which Stop TB launched last week, which aims to diagnose and treat 90% of all TB cases and to get 90% of those diagnosed with TB to complete their treatment.
South Africa started to implement the plan last year.
Many people with TB currently don’t complete their treatment, particularly those with drug-resistant TB, for which ordinary TB medication isn’t effective. Ordinary TB takes six months to treat, while drug-resistant TB can take up to two years. According to Stop TB’s executive director, Lucia Ditu, drug-resistant TB patients on average have to take 28 000 pills over 18 months, including a daily, painful injection for the first six months of their treatment.
Stop TB’s plan would, however, cost $56-billion to implement and there is a considerable funding shortfall.
On Monday, the US-based activist group Treatment Action Group (TAG) released a report that found worldwide funding for TB research fell $1.3-billion short of global targets in 2014. Total funding of $674,036,492 in 2014 amounted to barely one-third of the $2-billion experts estimate the world must spend on TB research and development each year to eliminate the disease. “TB has never summoned the political will, financial investment, and scientific energy equal to its outsized toll on human health and well-being,” the report said.
But Motsoaledi warned that TB advocates should learn from their HIV colleagues. “When antiretroviral drugs were unaffordable [two decades ago], we got the prices down. We worked with the Clinton Foundation and explained the economies of scale to the pharmaceutical companies. First, we got the monthly price of treatment down to R300 a month, now we pay R89 a month with combination treatment [a three-in-one-ARV pill]. It can also be done with TB treatment, particularly in the case of multidrug-resistant TB drugs, but the question is: are we willing to do that?”