Novartis Foundation for Sustainable Development
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What is tuberculosis and how can it be tackled?

Disease features and prevalence

Tuberculosis (TB) is not only a major killer in developing countries, it is also on the rise in the North (e.g. in former Soviet states). More than 9 million people worldwide are infected every year, of which 1.7 million die. In Tanzania, about 60,000 TB cases are detected annually. In 2002, 800 people died of TB in the United States.

TB is an infectious disease caused by mycobacterium tuberculosis. When speaking, sneezing, or coughing, TB-positive patients expel microscopic droplets containing the TB bacteria which are then inhaled by other people. The disease exhibits a combination of symptoms, notably a productive cough, weight loss, night sweats, light fever, appetite loss and general lethargy.

What most people do not know is that around 1.6 billion people worldwide have the TB bacterium in their bodies but only around one in ten latent infections will progress to the active disease, which can be fatal if left untreated. Factors which increase the risk of developing the active disease include incorrect treatment of TB, general (immune) deficiency, alcohol/drug addiction and HIV co-infection. Out of the annual 1.7 million death cases worldwide, 27% are HIV co-infected.

Current treatment and control strategy

TB has been curable since antibiotics were developed. The treatment usually takes six to eight months and adherence to treatment is crucial for the patient to be cured. The WHO recommended that gold standard fixed-dose combination therapy containing rifampicin, isoniazid, pyrazinamide and ethambutol, produced by Sandoz (Novartis group), shortens the treatment period from eight to six months. However, if patients terminate treatment prematurely, there is the risk of severe relapse or death.

The Directly Observed Treatment Short Course (DOTS) recommended by the WHO aims to ensure patient adherence and to prevent resistances. Under DOTS, patients are therefore compelled to take their daily doses under supervision. For the gold standard fixed-dose combination therapy, supervision is all the more needed throughout the treatment period since rifampicin is given during the entire six months. Rifampicin is an efficacious drug and hence needs to be protected against resistance.

Resistance of TB bacteria is a major challenge: Multi-Drug Resistant TB (MDR) as well as Extreme-Drug Resistant TB (XDR) stems have developed and pose a threat to TB patients’ lives. In 90% of the cases, XDR is fatal. Both forms of drug-resistant TB can occur when patients do not take the full treatment course.

The contribution of Novartis, the foundation and other players

The major source of funding for TB control activities is the Global Fund for HIV/AIDS, TB and Malaria. The main technical and advocacy body is the Stop TB Partnership Program bringing together governments, the private sector and NGOs. Located at the WHO, its secretariat also manages the Global TB Drug Facility. Novartis supports the fight against TB with a country-wide drug donation to Tanzania, enabling the treatment of half a million patients since 2004. The fixed-dose combination therapy is provided free of charge in collaboration with the Stop TB Partnership and the Global Drug Facility.

Together with the Tanzanian National TB and Leprosy Control Program and other partners, the Novartis Foundation for Sustainable Development has been supporting drug donation with the introduction of a Patient-Centered TB Treatment (PCT) approach, whereby patients can choose where they want to be treated (at the health facility or at home supervised by a family member).

 

Publications (foundation / partner organizations)

Assessment of patient preference in allocation and observation of anti-tuberculosis medication in three districts in Tanzania
Research article
Download > [en] (PDF, 77.1 KB)

 

Social marketing campaign in the fight against tuberculosis in Tanzania

Download > [en], [de] (PDF, 61.0 KB)

 

Interview with Saidi M. Egwaga about the fight against tuberculosis in Tanzania

Download > [de], [en] (PDF, 69.3 KB)
 

Links

 

Annual report 2012

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Symposium - What does it take to eliminate a disease?

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Project example

Patient-centered TB treatment in Tanzania
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