Tuberculosis

FY2018 Funding Recommendation:  
$236 million

 

Funding History

       Enacted   

       House/Senate FY2017 Request  

       InterAction's FY2018 Recommendation


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Justification

 Key Facts

  • TB is the single biggest killer of all infectious disease agents, killing 4,900 people each day. As an airborne disease that is found in every state in the U.S., TB presents a unique threat.

  • Treating MDR-TB involves 250 injections and 15,000 pills over a 2-year period, and side effects often include permanent hearing loss. Recent data indicates that an estimated 480,000 people developed globally MDR-TB in 2015, but only about 25% of people with multidrug-resistant (MDR) TB globally are being identified and treated

  • Since 2000, in the 23 countries where USAID helps fight TB, the TB death rate has dropped by more than 30% and new cases have fallen by 19%. The US now has a major opportunity to escalate the battle against TB, including drug resistant TB, using cost-saving innovations.

Tuberculosis (TB) is a contagious, airborne disease that sickens approximately 10.4 million people (active TB) and kills about 1.8 million people each year. It is particularly dangerous to young children, who can quickly become ill once infected and are at special risk of developing severe forms of TB, which can leave them blind, deaf, paralyzed, or mentally disabled. It is also a leading killer of HIV-positive people: in 2015, 1 in 3 HIV deaths was due to TB. It is the third leading cause of death for women of reproductive age globally, and in 2015, World Health Organization data showed that TB is now the leading cause of death from infectious disease.

The continued spread of drug-resistant TB, which is very difficult and expensive to treat, is a serious global health security threat. Treating multidrug-resistant TB (MDR-TB) involves 250 injections and 15,000 pills over a 2-year period, and side effects often include permanent hearing loss. Currently, only about 25% of people with MDR-TB globally are being identified and treated. However, the US now has a major opportunity to escalate the battle against drug resistant TB using new, cost-saving innovations.

Due to U.S. leadership, in part because of USAID’s extraordinary work through its TB Program, programmatic and technical assistance is being provided to 23 of the most highly burdened countries to prevent the development of drug-resistant strains and support the research and development of new, urgently needed tools to diagnose, prevent, and treat the disease. 

USAID’s TB program represents the commitment and determination of the U.S. government to prevent suffering, save lives, and create a brighter future for families in the developing world and in communities across the United States. As an airborne infectious disease, TB has no borders and can be found in all US states. 620 cases of Multi-drug Resistant TB (MDR-TB) occurred in the US from 2009 to 20141, severely straining state public health budgets, with treatment costs averaging $154,000 per person for MDR-TB and about $500,000 for Extensively Drug Resistant TB (XDR-TB)2. Strong global TB control is also therefore in our national interest in order to prevent a costly increase in domestic cases. In March of 2015, the U.S. announced the development of the National Action Plan for Combating Multidrug-Resistant Tuberculosis with targets for scaling up services to identify, treat, and prevent drug-resistant TB in the U.S. and globally, and for the development of new diagnostic, treatment, and prevention tools. This plan must be accompanied by the necessary funding and resources required for the implementing agencies, including U.S. Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

As part of that funding, InterAction believes $236 million – a number with strong bipartisan congressional support – for USAID’s global TB program will enable further success and provide continued support to countries to plan effectively for TB efforts, maximizing both U.S. resources and those through the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

 


Success Story

Anika’s Story: Intensified TB Case-Finding in Bangladesh

Anika was a 22-month-old baby girl living in Belai Chandi Kuthipara in the northern part of Bangladesh when she became sick. She was admitted to the LAMB’s Missionary Hospital in Parbotipur, where the USAID-funded Challenge TB project led by Management Sciences for Health (MSH) is funding active case-finding among high-risk groups such as children, people living with HlV, and diabetics. Anika had classic tuberculosis (TB) symptoms (fever, cough, and weight loss) combined with a suspect chest x-ray, so she was put on treatment for TB.

Diagnosing TB in children is especially difficult due to their inability to provide a sputum sample. A process called gastric lavage and sputum-smear microscopy were used to complete the diagnosis for Anika and showed a positive result for TB.

After six months of directly observed treatment Anika was finally cured. Contact tracing was done to find the origin of the TB, her parents were screened as were those around her in the neighborhood, but no one suffering from TB symptoms was found.

Unfortunately, one year later, Anika became ill again and her parents returned to the hospital. As it was a relapse case, the doctor sent her sample for GeneXpert testing. GeneXpert is a highly sensitive test that can detect drug resistant strains of TB; it indicated that this time Anika had drug resistant TB (DR-TB).

Anika was referred to the National Institute of Chest Diseases and Hospital in Dhaka, where Challenge TB supports treatment initiation for DR-TB. Anika was hospitalized for two months until she showed improvement, before being ready to continue her treatment at home under community-based programmatic management of DR-TB provided by Challenge TB-trained out-patient teams.

Initially the drugs made her nauseous, but after the doctor taught her parents how to administer the medicine with sugar and milk she was able to tolerate them. Anika’s family also receives social support from Challenge TB in the form of food and funds to cover all the costs relating to her treatment. Through all these carefully coordinated efforts, her physical condition is slowly improving.

 “Thanks to the doctor in the hospital who taught me how to mix the drug with milk and sugar to make them palatable to my child, I can now administer her drugs myself”

 “আল্লাহর রহমত” by the blessing of Almighty God we are getting all kinds of help and support. Otherwise, how would we able to cure our daughter of this dreadful disease?”

Childhood TB cases constitute approximately 3% of all reported TB cases in Bangladesh, but the actual disease burden of childhood TB is unknown. Only a small proportion of the estimated number of childhood TB cases are diagnosed, and DR-TB is on the rise (12 children have been treated for multi-drug resistant TB since 2008). Anika’s story shows that intensified case-finding, investing in training, and new technologies can and will save lives.

Photo: Francies Hajong/MSH

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