world TB day

*** HAPPY WORLD TB DAY! ***

March 24 commemorates the discovery by Robert Koch of the bacterium that causes tuberculosis, and it is an opportunity to raise awareness and assess the past year's work in the fight to eradicate TB.

I spent the first part of the morning in the clinic as usual. I talked for a long with time with a patient who told me out of the blue, after a long, jovial conversation, that he has HIV. The MDR-TB patient I mentioned in the last post could barely move today because of the gastrointestinal side effects of his medications. The sobering atmosphere of the reality of TB for so many was a striking contrast to the World TB Day event I later attended, organized by the governmental Ministry of Health and its TB Control Program. Representatives from the government, USAID, WHO, the Global Fund, and various NGOs gathered at a high-end hotel to pat each other on the back and discuss recent advancements in the agenda to end TB. It was an interesting morning.

Tuberculosis is one of the oldest diseases known to humanity, and is thought to have been passed to human beings by cows when people began to domesticate livestock (there is a very similar bovine strain that predates the human strain). It is caused by a bacterium with which about 1/3 of the world's population is infected. However only 10% of people will ever develop active disease. Immuno-compromised people, particularly those with HIV, chronic malnutrition, or other health problems (mostly related to poverty) are the most likely to develop active disease.

TB most commonly affects the lungs, but extrapulmonary TB - or disease in other parts of the body - can also occur. It was once known as "consumption," as typical symptoms include a long-term, productive cough, night fevers, fatigue, weight loss, and other signs of general wasting away. Perhaps the most dramatic and well-known symptom is hemoptysis, or the bloody cough that appears when severe infection goes untreated. However, TB is treatable with an intense regimen of antibiotics.

The international standard for treatment is known as Direct Observed Therapy, Short-Course, or DOTS. DOTS is a protocol for administering medicine that requires patients to take their pills in the presence of a health-care worker in order to ensure that they receive each dose. As with many bacterial illnesses, improper or incomplete dosing can create serious problems of recurrent infection and bacterial resistance, and the TB treatment regimen is particularly difficult to keep up with. Current challenges to the eradication of tuberculosis include the syndemic (or co-epidemic) of TB and HIV and the increasing rate of multiple drug-resistant TB (MDR-TB).

- TB incidence (or number of new cases annually) in the Dominican Republic is around 69/100,000, a rate surpassed only by Haiti when compared to other Caribbean and Central American countries. Other estimates, however, place incidence even higher, above 85/100,000.
- 45% of new cases occur in the National District, where the capital city of Santo Domingo is located.
- The DR is tied with Peru for the highest rate of MDR-TB in the Americas, and is one of the top 19 countries in the world in terms of MDR-TB incidence.
- About 6.8% of TB patients are also infected with HIV in the DR, but this rate varies widely according to region. In the poorest regions of the country, co-infection reaches up to 50%.
- The DR has rapidly expanded its coverage of DOTS health services, from virtually no coverage in 2000 to 85% coverage in 2008 (that is, 85% of the population now lives within 30 minutes from a health center administering DOTS TB treatment). It's an improvement, but the DR still has the sixth lowest coverage among American countries.
- The World Health Organization's target goals of 70% case detection and curing at least 85% of cases still have not been reached in the DR.

*** HAPPY WORLD TB DAY! ***