FY2016 Funding Recommendation:
President's FY2016 Request
InterAction's FY2016 Recommendation
Tuberculosis (TB) is a contagious, airborne disease. Every year it kills about 1.5 million people and in 2013, 9 million people fell ill with the disease. It is particularly dangerous to young children, who can quickly become ill once infected and are at special risk of having severe forms of TB, which can leave them blind, deaf, paralyzed, or mentally disabled. The World Health Organization calculates that the average TB patient loses three to four months of work-time each year and experiences a loss of up to 30% in yearly household earnings.
USAID’s TB program provides critical technical and programmatic assistance to the 27 most highly burdened countries. Program funding is used to detect and treat TB cases, prevent further spread of the disease and provide urgently needed expertise to address drug resistant strains. USAID also supports research and development for new tools to fight the disease. The Program carries out functions distinct from those of PEPFAR (the President’s Emergency Plan for AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. For instance, it assists countries in setting up rigorous evaluation systems to monitor TB programming from all funding sources, including the Global Fund. USAID has helped countries procure medication and avoid dangerous stockouts, while also lowering medication costs for drug resistant TB by as much as 32%, through its contribution to the Global Drug Facility.
Despite these significant contributions to fighting TB, serious challenges remain:
- A large numbers of cases (about 3 million) are not being reported to public health authorities, and are likely not being diagnosed or treated.
- Some TB strains have developed resistance to standard anti-TB drugs and are spreading, including to the U.S. Recent data indicates that an estimated 480,000 people developed multidrug-resistant TB (MDR-TB) in 2013 and 210,000 people died.
- There is currently no TB vaccine for adults and adolescents, and the vaccine for infants is only partially effective.
In 2008, Congress authorized $4 billion in funding over five years for USAID’s TB program, an authorization level that congressional appropriations have never reached. InterAction believes $400 million – a number with strong bipartisan congressional support – is a reasonable level for FY2016 funding. This investment will enable further development and deployment of updated diagnostics and drug regimens, as well as provide continued support to countries for effective planning to maximize the use of Global Fund and domestic resources.
Treating multidrug-resistant tuberculosis at home
In 2009 Ruhul Amin from Chittagong, the port city of Bangladesh, began to experience a persistent cough and fever – typical symptoms of tuberculosis (TB). He tried medicine from a local pharmacist; when they did not work, he was referred for a sputum test and diagnosed with TB. Unfortunately, Ruhul’s TB did not respond to the routine treatment or the follow up therapy. After additional investigations, he was finally diagnosed with multidrug-resistant TB (MDRTB), often caused by irregularly taking anti-TB drugs.
Due to a shortage of beds at the hospital, Ruhul had to wait 10 months before starting his treatment there. After a short stay at the hospital, he was transferred home to complete the treatment under the community-based treatment model. The TB CARE II project, supported by USAID, introduced this model in Bangladesh to increase early access to MDRTB treatment. The project supports a DOT provider to administer drugs and provide other clinical support to the patient on a daily basis. A small monthly allowance for nutritional support helped Ruhul stay strong and fight the disease. Most of all, receiving treatment at home allowed him to get continuous care and mental support from his family members.
The long wait for correct diagnosis and treatment not only delayed Ruhul’s recovery – he lost his small business and ran into debt to support his family. In August 2013, after 20 months of strict adherence to the treatment regimen, Ruhul was declared cured of the disease. Ruhul has since restarted his business and is leading a healthy, productive life. The patient-centered support provided by the project was critical in his being able to beat the disease.
Photo Credit: University Research Co