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[e-drug] WHO on DOTS, DOTS*, DOTS+


Press Release WHO/ 20
23 March 2004
EMBARGO: 23 March 2004, 18.00 GMT


  Health, Finance Ministers Meet In New Delhi On Challenge Of Treating An
                   Additional 1 Million Patients A Year

Geneva/New Delhi - The number of tuberculosis patients diagnosed and
treated under DOTS(superscript: *), the internationally recommended
strategy for TB control, is now rising much faster than at any time since
DOTS expansion began in 1995, according to a new report by the World Health
Organization (WHO). Indeed, the past two years have witnessed accelerated
growth in the implementation of DOTS programmes worldwide.

The 2004 Global Tuberculosis Control report confirms that DOTS programmes
are now treating three million TB patients every year, an increase of more
than one million patients compared to just two years ago. That increase is
nearly double the average annual increment of 270 000 patients during the
previous six-year period, and the trajectory is still heading upward. India
is leading the surge with more than a quarter of all additional DOTS cases
being treated, followed by smaller but significant increases in five other
key countries with high rates of TB: South Africa, Indonesia, Pakistan,
Bangladesh and the Philippines.

The findings of the report will be presented on Wednesday by LEE Jong-wook,
WHO Director-General, at the opening session of the 2(superscript: nd) Stop
TB Partners' Forum in New Delhi, a two-yearly summit of donors, technical
agencies, NGOs and ministers from the 22 high-TB burden countries under the
umbrella of the global Stop TB Partnership.

"DOTS expansion is one of the major public health success stories of the
past decade, one that is saving thousands more lives every day,"  Dr Lee
said. "But to reach the 2005 targets for detection and treatment, the
challenge now is to add another one million TB patients to DOTS programmes
each year. Many of these new cases will be recruited from the hospitals and
private health sector in Asia, especially China, and from beyond the
present limits of health systems in Africa."

The global 2005 targets for TB control are to detect 70% of all infectious
TB cases and cure 85% of those cases detected. According to the WHO report,
the case detection rate has risen to 37% and cure rates to 82%. Meeting the
2005 targets will put the world's TB control programmes on the path to
achieving the Millennium Development Goal (MDG) of halving the global TB
burden by 2015.

Expanding and strengthening DOTS is key to halting the spread of TB because
it is cost-effective, ensures treatment compliance, and prevents the
development of drug-resistant strains of TB. Of the 210 countries that
reported TB case notifications and/or treatment outcomes to WHO in 2002,
180 are today implementing the DOTS strategy and providing access to
services for nearly 70% of the world's population

The World Bank, a key member of the Stop TB Partnership and a leading
financier of TB-related programmes in developing countries, welcomed the
WHO report as evidence that donor funding for expanding DOTS treatment had
proven effective in improving the health and welfare of communities
afflicted by the disease.

"This new evidence is important. Speeding up TB case detection is the
critical first step in curing more patients and driving down disease," said
James Wolfensohn, President of the World Bank. "This gives us solid ground
to push for the greater support needed to reach our goals faster.
Strengthening overall health systems to reach the poor will be another
critical route towards controlling TB."

There are an estimated 8.8 million new cases of TB each year of which 3.9
million are infectious. The number of new cases is increasing rapidly in
Eastern Europe, mainly countries of the former Soviet Union which only
recently started to implement DOTS. A special surveillance report issued
last week by WHO found that TB patients in parts of Eastern Europe and
Central Asia are 10 times more likely to have multidrug-resistant TB than
in the rest of the world. TB incidence rates also continue to rise at an
alarming rate in African countries with high HIV prevalence.

"HIV/AIDS is driving the TB epidemic in southern and eastern Africa and
will  worsen the situation in Eastern Europe, India and China in the years
ahead," said Dr Jack Chow, the WHO Assistant Director-General for HIV/AIDS,
Tuberculosis and Malaria. "We cannot control one without controlling the
other, and must begin rapidly scaling up TB/HIV collaborative activities to
provide a synergy of prevention, treatment and care for co-infected

Another key document to be presented at the Delhi summit will be a progress
report on the Global Plan to Stop TB, the strategic roadmap which guides
the development and work of the Stop TB Partnership. The report assesses
progress in eight key areas: DOTS expansion; DOTS-Plus for
Multidrug-Resistant (MDR) TB; TB/HIV, research and development for new TB
drugs, diagnostics and vaccines; the Global TB Drug Facility; and resource
mobilization. "The Global Plan covers the five-year period from 2001-2005,
and this progress report will tell us how well we are doing in meeting the
process targets of the Plan at the midway point," said Ernest Lowensohn,
chairman of the Stop TB Coordinating Board.


For further information about the WHO report and Stop TB Partners Forum,
please contact: Michael Luhan, Stop TB Partnership, mobile: +41 79 509 0643
or +91 98 1899 8485; Glenn Thomas, WHO Stop TB Department, mobile: +41 79
509 0677; Harsaran Pandey, WHO Regional Office for South-East Asia, Tel:
+91 11 2337 0971

The following Forum documents can be accessed at www.who.int and
www.stoptb.org:  WHO 2004 Global Tuberculosis Control report; Report of the
2(superscript: nd) Ad hoc Committee on the TB Epidemic Intensified Support
and Action Countries (ISAC); External Evaluation of the Stop TB Partnership
Interim Policy for TB/HIV Collaborative Activities

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