Purpose of Initiative
Tuberculosis (TB) is a contagious disease estimated to have already infected a third of the world’s population. Of those infected, 5-10% will develop the disease. Every year, nine million new cases of TB occur and two million people die. TB causes one out of three HIV/AIDS deaths. The global resurgence of TB has been fueled by the HIV/AIDS pandemic, inadequate public heath services in developing countries, and the rapid spread of drug resistant TB. Tuberculosis threatens the poorest and most marginalized groups, devastates families and communities, and undermines a country’s progress toward economic development. The potential loss of productivity could cost up to 4 to 7 percent of a developing nation’s GDP.

Partners
The Stop TB Partnership is a global movement of more than 280 public and private organizations dedicated to the long-term measures needed to control and eventually eliminate TB. For a complete listing of the partners, see the Stop TB Partnership website (http://stoptb.org).

Partnership Targets
The Stop TB Partnership has four strategic objectives with three specific targets:       

Objectives

• Expand the highly effective Directly Observed Treatment Short Course Strategy (DOTS) so that all people with TB have access to effective diagnosis and treatment. DOTS programs, which are recommended by the World Health Organization (WHO), identify TB patients, provide them with drugs and ensure an uninterrupted supply of drugs until they are cured. Health workers "directly observe" that patients take their medicine daily until the full treatment is completed.
• Adapt DOTS to meet the emerging challenges of HIV and TB drug resistance.
• Improve existing tools by developing new diagnostics, new drugs, and a new vaccine.
  Strengthen the global Stop TB Partnership so that proven TB-control strategies are effectively applied.

• By 2005: 70 percent of people with infectious TB will be diagnosed and 85 percent cured.
• By 2010: The global burden of TB (deaths and prevalence) will be reduced by 50 percent (compared to 2000 levels).
• By 2050: The global incidence of TB disease will be less than 1 per million people.

Progress Toward Targets
From the most recent data at the end of 2002, 37 percent of the estimated TB cases had been diagnosed, more than half way to the 2005 target of 70 percent. Treatment success rates averaged 82 percent, close to the 2005 goal of 85 percent.

DOTS is now implemented in 180 countries and explicit strategic plans have been completed in all 22 high burden countries, which represent 80 percent of the global TB burden. Implementation of these plans has already begun. The United States Agency for International Development (USAID) field mission programs are providing technical assistance, training, and infrastructure support to DOTS programs in 34 countries, including 15 of the 22 high burden countries - Bangladesh, Brazil, Cambodia, Congo, Dominican Republic, Ethiopia, Haiti, India, Indonesia, Kenya, Mexico, Philippines, Russia, South Africa and Uganda.

The Stop TB’s Global Drug Facility (GDF) has provided drugs to treat almost 2 million TB patients in 49 countries. GDF has also significantly reduced anti-TB drug prices, which have decreased to less than $11 for a standard six-month course of treatment. The WHO and the U.S. Centers for Disease Control and Prevention (CDC) are analyzing data from drug resistance studies, involving over 60 countries, to determine patterns of resistance and selection of appropriate drugs. Nineteen pilot projects have begun to assess the use of second-line drugs for effectiveness against multi-drug resistant (MDR) TB.

Under guidance from the WHO, interim policy and recommendations for collaborative TB/HIV activities have been completed. Joint TB/HIV pilot projects have been established and evaluation is underway or completed. Networking has begun to coordinate the Stop TB Partnership activities with the Global Fund to Fight AIDS, TB, and Malaria.

Next Steps
Recognizing the need for accelerating DOTS expansion, the WHO has identified intensive support actions for countries and the Stop TB Partnership to focus future efforts. Partnership countries are developing plans for human resource development to meet training needs and capacity building that improves TB diagnosis, expands DOTS, coordinates TB/HIV treatment and control, and combats the rapid growth of MDR-TB. In addition, development of new strategies for communication and advocacy will facilitate effective implementation of TB control and prevention at the community, national, and regional level.

Resources
The U.S. Government (USG) has committed $200 million to global TB control efforts, including research conducted by the Department of Health and Human Services’ and its agencies - the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration - and support for country programs and research through USAID. The USG has pledged $1.97 billion through 2008 and contributed $623 million through 2003 to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Seventeen percent of support for the Global Fund has been dedicated to TB work. USAID resources have increased from $9.7 million in 1998 to roughly $82 million committed in fiscal year 2004. These resources not only go toward expanding DOTS, but also for strengthening technical assistance and human resource capacity, providing laboratory facilities and equipment, and improving drug quality and availability. In addition to financial contributions, USAID provides technical assistance to Stop TB’s Global Drug Facility to ensure that adequate attention is paid to proper drug management issues in GDF grants.

U.S. Government Primary Point of Contact
Agency for International Development, Bureau for Global Health: Clydette Powell, MD, MPH, (Phone: 202-712-0027; Email: cpowell@usaid.gov) 
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