TB is still a major cause of death worldwide. There were an estimated 8.8 million new TB cases in 2005, 7.4 million in Asia and sub-Saharan Africa. A total of 1.6 million people died of TB, including 195 000 patients infected with HIV. However, the global epidemic is on the threshold of decline. TB prevalence and death rates have probably been falling globally for several years. In 2005, the TB incidence rate was stable or in decline in all six WHO regions, and had reached a peak worldwide. However, the total number of new TB cases was still rising slowly, because the case-load continued to grow in the African, Eastern Mediterranean and South-East Asia regions.
The World Health Organization (WHO) estimates that the largest number of new TB cases in 2004 occurred in WHO's South-East Asia Region, which accounted for 33% of incident cases globally. However, the estimated incidence in sub-Saharan Africa is nearly twice that of the South-East Asia Region, at nearly 400 cases per 100 000 population. Both the highest number of deaths and the highest mortality per capita are in the WHO African region, where HIV has led to rapid growth of the TB epidemic, and increases the likelihood of dying from TB.
Although most government health services now recognize that TB control must go beyond DOTS, the broader Stop TB Strategy is not yet fully operational in most countries. More than 26 million TB patients have been treated under DOTS, but the world’s TB control programmes narrowly missed the 2005 targets for case detection and cure, and are not yet on course to meet the Millennium Development Goals by 2015.
WHO’s 2005 targets for DOTS programmes of 70% case detection and 85% cure were narrowly missed globally: case detection was 60% (95% CI 52–69%); treatment success was 84%. However, both targets were achieved in the Western Pacific Region, and treatment success exceeded 85% in the South-East Asia Region.
A new global strategic approach has been recently approved by WHO, recognizing the key challenges of TB/HIV and MDR-TB. The six component of the STOP TB strategy are:
1) Pursuing high-quality DOTS expansion and enhancement;
2) Addressing TB/HIV, MDR-TB and other challenges;
3) Contributing to health system strengthening;
4) Engaging all care providers;
5) Empowering people with TB, and communities;
6) Enabling and promoting research.