As the curtain draws upon the 43rd Union World Conference On Lung Health in Kuala Lumpur, all those involved in health care in some way or the other - TB affected communities, governments, donors, researchers, healthcare professionals, broader civil society, among others - need to deliberate upon this dictum.

(Hara Mihalea is a noted Public Health and Tuberculosis Consultant. She is a Greek American and trained as a specialist on adolescent reproductive health. She has worked on all aspects of public health and was one of first groups of people in 1985 that were trained as HIV counsellors at CDC. Then in 1995 she moved to Thailand and has since dedicated her life solely to the cause of TB prevention, care and control. This is based on an interview she granted to CNS onsite at the 43rd Union World Conference on Lung Health in Kula Lumpur.)

With nearly nine million new cases and 1.5 million deaths per year, tuberculosis is a major global health threat, apart from entailing significant financial and economic burdens. The increase and spread of drug resistant TB makes the problem even more dangerous. The only currently available vaccine, BCG, offers limited protection and is not effective enough to stop the TB epidemic. New safer and more effective vaccines are therefore urgently needed.

In 2011 India had 61.3 million people living with diabetes (17% of the global incidence of 366 million) with 983,000 deaths (20% of the global figure of 4.6 million) attributable to the disease. India also accounts for 21% of the global incidence of tuberculosis (TB) with 1.98 million people developing TB and nearly 300,000 dying of it every year. Diabetes Mellitus is a non curable, non communicable metabolic disease that occurs when either the pancreas fail to produce sufficient insulin, (the hormone that regulates blood sugar), or when the body cannot use the insulin it produces effectively. It can be treated and controlled effectively although, over a period of time, it does increase the risk of heart disease and stroke and can cause kidney failure, blindness and nerve damage.

India is a very high burden TB country, accounting for 21% of the global incidence. It is estimated that TB kills 300,000 Indians annually: one death every 2 minutes. The situation is no better when it comes to multidrug-resistant TB (MDR-TB). India, with about 100,000 of its TB patients having drug-resistant strains, represents over 20% of the world’s MDR-TB burden. Globally 440,000 MDR-TB cases emerge and 150,000 people die of MDR-TB every year. Citizen News Service (CNS) gathered perspectives and opinions on MDR-TB and HIV from a range of experts and advocates attending the XIX International AIDS Conference (AIDS 2012) in Washington DC.

Well, that is the difference of cost in treating a simple tuberculosis (drug susceptible TB) patient to the one suffering from drug resistant TB (DR TB) according to Lucica Ditiu, Executive Secretary of The Stop TB Partnership, who made a fervent appeal for ending tuberculosis and called for zero TB and HIV deaths, while appearing on a live web-cast talk show on ‘tuberculosis and HIV: protecting the vulnerable women and children’ presented by The Stop TB Partnership and the International Federation of Red Cross and Red Crescent Societies (IFRC) during the XIX International AIDS Conference in Washington DC. She was optimistic that just by scaling up the existing tools and services in TB we can save one million lives by 2015.

The dual HIV-TB epidemic has posed a challenge for both TB and HIV efforts at all levels. Although the number of people living with HIV (PLHIV) screened for TB increased almost 12-fold, (from nearly 200 000 to over 2.3 million people) and testing for HIV among TB patients increased 5-fold (from 470,000 to over 2.2 million) between 2005 and 2010, almost a quarter of all AIDS deaths every year are still caused by TB despite it being preventable. An estimated 910,000 lives were saved globally over the last six years through the implementation of collaborative TB/HIV activities, yet only 46% of TB patients living with HIV received ART in 2010. Not all people living with HIV who enrolled into care were screened for TB and a far smaller proportion received isoniazid preventive treatment (IPT). In many high burden countries there has been little progress in the implementation of collaborative TB/HIV activities. 

During the opening plenary session of XIX International AIDS Conference (AIDS 2012), Secretary of State of USA Hillary Rodham Clinton made a fervent appeal to end the epidemic of AIDS and hoped to be able to stop the AIDS Memorial Quilt (which has the names of all those Americans who have died of AIDS) from growing any further. It is disappointing that not one of the distinguished speakers made even a passing reference about the need to control the spread of the tuberculosis (TB) bacteria, which stalks the earth hand in hand with the HIV virus and is the biggest cause of deaths among people living with HIV (PLHIV). Activists and health advocates however used this major opportunity to draw attention to TB/HIV by wearing face masks when Clinton was speaking. This activism has put the spotlight once again on the urgent need for better access to and research on life-saving tools and programs to fight TB/HIV. 

At least half a million children become ill with tuberculosis (TB) and up to 70 000 children die of it every year. The World Health Organization has estimated that around 10% of global TB caseload occurs in children (0-14 years). However, there are reports that children account for up to 40% of all cases being treated for TB. Children are also susceptible to the dual epidemic of TB--HIV. Most children will catch tuberculosis from a family member and if they are living with HIV they are even more in danger of developing more severe forms of tuberculosis with higher mortality rates. HIV-infected children are at 20 times greater risk of TB disease than HIV-negative children and at much higher risk of TB-related deaths. Paediatric TB has until recently not been a main priority of global TB control efforts for various reasons.

Despite the fact that TB is curable and HIV is treatable, an estimated 8.5 million new and relapsed TB cases were reported in 2010, and an estimated 1.4 million died, which included 350,000 people living with HIV and co-infected with TB.