IUATLD - International Union Against Tuberculosis and Lung Disease

• Forschungsstelle: DEZA
• Projektnummer: 7F-03969.05
• Projekttitel Englisch: IUATLD - International Union Against Tuberculosis and Lung Disease

Schlüsselwörter (Deutsch)

IUATLD - International Union Against Tuberculosis and Lung Disease
Forschung
Gesundheitswesen
Beziehungen
Ausland

Kurzbeschreibung (Englisch)

Tuberculosis is a disease of poverty. Currently, 1/3 of the world’s population is infected with the tuberculosis bacillus of whom 8 million people will develop the disease and 2 million will die of it each year. In developing countries, where 95% of cases and 98% of Tuberculosis (TB) deaths occur, the disease is responsible for some 25% of the preventable disease burden. It has also to be kept in mind that TB and HIV are inextricably linked. 70% of the world’s 14 million people who are co-infected with HIV and TB live in Africa.

The Association (legal status: International NGO) is based in Paris and was officially founded in 1956. Its denomination was changed in 1989 to become the International Union Against Tuberculosis and Lung Disease (IUATLD now replaced by the abbreviation The Union). The Union is a membership organisation with members from all regions of the world. Switzerland is a member through the “Schweizerische Lungenliga”.

The Union’s aim is the prevention and control of tuberculosis and lung disease as well as related health problems on a worldwide basis, with a particular emphasis on low income countries. It has developed in the 1980s with support from SDC the Directly Observed Treatment Strategy (DOTS) strategy which is now applied in almost all countries worldwide. The Union is putting an additional focus on the interaction between HIV/AIDS and TB and is collaborating in this area with countries such as Benin, DR Congo, Uganda, Zimbabwe and Myanmar. It is The Union’s policy to only work in a country with the agreement of the government authorities, ensuring that all activities fit into the plans of the respective countries and contribute to a sustainable development of programmes and services.

Today, DOTS is still the main pillar of the internationally recognized TB control strategy. An expanded, new six-point strategy (Stop TB strategy), developed by WHO and partners builds on the successes of DOTS while also addressing the key challenges facing TB control including TB/HIV and Multi-Drug Resistant (MDR)-TB. The new strategy also seeks to strengthen health systems, engage all care providers, empower people with TB and communities, and promote research.

Progress in DOTS implementation is remarkable: More than 20 million patients have been treated in the last decade and it is estimated that another 50 million patients will benefit from the Stop TB strategy to reach the Millennium Development Goals in 2015. However, new challenges are going to demand additional and reinforced commitment from all partners. In many countries in Sub Saharan Africa TB/HIV is affecting many families and communities with coinfection rates of up to 70%. One of the new worldwide threats are the outbreaks of MDR-TB and Extensively Resistant Tuberculosis (XDR TB), identified in several countries (developed and industrialized) worldwide. MDR and XDR TB are being found especially in those countries which have not been able to implement sound TB control strategies. It is critical that we not only tackle drug resistant cases but more importantly prevent these cases by ensuring that basic rules of TB control are being respected. The Union is represented in the Green Light Committee of the WHO which oversees and approves funding requests from countries affected by MDR TB.

The Union has been supported by SDC since 1978. This contribution was initially for the assistance to the Tanzanian National TB Control programme, then for seconded personnel (Executive Director, 1992-1997) and from 1998 onwards for the funding of core costs. The present credit proposal is a continuation of preceding credit proposals covering the period from 1998–2007. The planned SDC core contribution of CHF 250’000 per year (approximately 0.5% of the total yearly Union budget) is as relevant as ever for The Union because it ensures that The Union is able to develop new innovative pilot projects and to attract additional donors and funds. SDC’s core contribution has a multiplying effect as has been shown in a recent external evaluation.

Projektziele (Englisch)

The overall objective of The Union is to improve lung health, particularly in low income countries, through advocacy, health promotion, prevention and intervention to reduce morbidity and mortality from respiratory diseases.

Abstract (Englisch)

TB was thought to be under control towards the end of last century. However, in 1993 the WHO had to declare TB a global health emergency since the magnitude of the problem changed dramatically during the 1990s due to deteriorating control in some parts of the world (notably Eastern Europe and the former Soviet Union), the spread of HIV, and population growth. Today, the disease threatens one-third of the world’s population. Without a coordinated control effort, tuberculosis will infect an estimated 1 billion more people by 2020, killing 70 million.

While anyone can contract TB, the disease thrives on the most vulnerable – the marginalized, discriminated against populations, and people living in poverty – since the transmission happens mainly through proximity and in people with bad health conditions. The lifetime risk to develop clinical disease for those infected with Mycobacterium tuberculosis lies between 5% and 10% in the absence of an effective TB Control programme, but it is much higher in the presence of other risk factors, such as co-infection with HIV. Without appropriate treatment, the case fatality rate reaches up to 50%.

HIV has fundamentally altered the epidemiology of TB. TB becomes reactivated in 5-10% of HIV-infected people per year. While 8% of global TB cases are attributable to HIV, in sub-Saharan Africa the figure is 40%. Annual TB case loads have increased up to seven-fold in the worst HIV-hit countries and current treatment strategies can no longer control the disease. In some countries up to 70% of TB patients are co infected with HIV.

The global proportion of MDR-TB is around 1-2% of all cases, but the problem is greater in MDR ‘hot-spots’ around the world. The trend in incidence of TB is upwards in sub-Saharan Africa and the Newly Independent States, but elsewhere is generally downwards. The misuse of second line drugs has led to the emergence of XDR TB and is affecting developing and industrialized countries.

The Union is the leading NGO dealing with TB. Its mission is the prevention and control of tuberculosis and lung disease, as well as related health problems, on a world wide basis and with a particular emphasis on low income countries. It is actively involved in technical assistance, training, research in more than 50 countries (2006).

The Union-managed FIDELIS project funded 33 projects in 14 countries, providing diagnosis and care for tuberculosis patients with little or no access to health services. In order to be closer to the basis, The Union has opened regional and country offices in India, China, Uganda, Myanmar, others planned in Mexico and Egypt.

The current international strategy for tuberculosis control (the DOTS strategy) was developed from research carried out by a physician within IUATLD with support from SDC. Progress in DOTS implementation is remarkable: In the last decade 20 million patients have been treated under DOTS. Case finding has increased to over 60% and treatment success has reached the WHO target of 85% in almost all countries which adopted DOTS.

In 2007, a network of over 40 courses in TB management, budgeting and planning methods, Human Resource Development and tobacco control were organized by The Union in countries such as Tanzania, Benin, El Salvador, Vietnam, India, Thailand, China, Indonesia, Bangladesh etc.