The World Health Organisation said this week that drugs to cure TB should be made available free to everyone in the world who needs them, and that it is ` essentially immoral not to make these drugs available free when they could save 200,000 lives each year`.
The declaration was made by Mario Raviglione, WHO's Stop TB director, at a press briefing during the Second International AIDS Society Conference on HIV Pathogenesis and Treatment in Paris.
A single course of TB treatment lasting six months costs $10. Over 70% of Africans do not have access to medicines to cure TB, nor to quality care, says HO. Mario Raviglione estimated that $1.2 billion is needed to provide the bare minimum of directly observed therapy (DOTS) for all who needed it. To bring the global TB epidemic under control, investing in infrastructure to deliver treatment and training to ensure treatment is given properly would require a further $1 billion. Raviglione estimates a gap of $300-400 million between funds available and those needed to provide the minimum package of treatment.
He also highlighted the need for better coordination between TB programmes and HIV programmes, such as TB screening for all who are diagnosed with HIV, and better access to HIV testing for those diagnosed with TB. Better quality proposals coordinating HIV and TB treatment programmes to the Global Fund to Fight AIDS, TB and Malaria are needed, he said, for these synergies to be realised.
WHO's established DOTS strategy has a number of principles, including the idea that TB treatments should be provided free of charge and should ONLY be provided through public health services.
In some countries, such as Botswana in Southern Africa, these objectives have been achieved, with excellent cure rates for smear-positive (infectious) TB. However, with a rising prevalence of HIV this is no longer adequate to control TB, as discussed here.
In India, where TB medicines are effectively sold to patients with little regulation by many private medical practitioners, this occurs despite the free availability of effective TB drugs through public clinics. The problem here is that the public clinics are often perceived to be substandard and patients therefore avoid them.
Additional problems occur when, as in the former Soviet Union, multi-drug resistant TB becomes widespread. MDR-TB requires prolonged treatment with more costly drugs and a single case can cost tens of thousands of dollars at current market prices. This situation is being addressed through an initiative called DOTS Plus, a partnership in which some pharmaceutical companies have agreed to provide drugs as donations or at lower cost.