RxPG News : Africa

African Union and UN Agencies launch HIV Prevention Acceleration in Africa

Tue, 11 Apr 2006 12:14:37 PST

( from http://www.rxpgnews.com ) In an attempt at stepping up the pace of HIV prevention in the continent, the AU and United Nations system in Africa will on Tuesday 11 April 2006 launch the Acceleration of Prevention of HIV Initiative in the African Region in Addis Ababa, Johannesburg, Ouagadougou and Khartoum. This is a follow up to the Declaration by the African Ministers of Health in 2005 to declare 2006 as a Year for Acceleration of HIV Prevention in the African Region, and called on Member States to intensify HIV prevention efforts.
Africa must now seize the moment to stop HIV, says AU Commission Chairperson, Prof. Alpha Konare. There are several proven interventions in the area of prevention; we have a secure and growing knowledge base to do the job; and there is unprecedented political commitment and increased funding to translate plans and programmes into services for our people, he said.

The AU Commission and the UN agencies agree that acceleration of HIV prevention deserves more serious attention in line with the goal of universal access to HIV prevention, treatment and care by 2010.

WHO Regional Director for Africa, Dr Luis Sambo, is of the opinion that the launch should serve as a wake-up call for Africa to take concrete measures to stop all forms of HIV infection. We must promote widespread awareness of HIV and how it is caused, and media campaigns and education are the best ways to do this. Africans must embrace HIV counseling and testing; while governments, in collaboration with partners, must work together to ensure wide availability of HIV prevention services, together with antiretroviral therapy.

According to UNAIDS, HIV and AIDS pose the greatest threat to security and development in Africa, therefore "HIV prevention and HIV treatment should be pursued with vigour said Michel Sidibe UNAIDS Director of UNAIDS country and Regional Support Department. UNAIDS notes that the number of new infections occurring in Africa must be dramatically reduced in the next few years to ensure that treatment, care and support remain economically and socially sustainable.

UNICEF Regional Director for East and Southern Africa says: It is unconscionable that every single day, nearly 2,000 infants are infected with HIV during pregnancy, childbirth or breastfeeding -- most of them in sub-Saharan Africa -- and that every single day some 6,000 young people between the ages of 15 and 24 contract the virus. This year presents an opportunity to change the course of the virus and of history. We in UNICEF are ready to help in every way in turning the tide."

Series of activities have been planned for the simultaneous launch of the HIV prevention initiative in the four locations, with Addis Ababa being the main launch. This will take place at the AU Headquarters and dignitaries expected include Ethiopian Prime Minister, Meles Zenawi, African Union Commission Chairperson, Professor Alpha Oumar Konare, the First Ladies of Rwanda and Ethiopia, representatives of UN, international and regional organizations, diplomatic corps, the private sector as well as youth and women associations, celebrities and People Living with HIV/AIDS.

Another launch ceremony will take place in Johannesburg on 11 April, which will bring together dignitaries including the countrys Minister of Health Dr. Manto Tshabalala-Msimang, the SADC
Executive Secretary, UNICEF Goodwill Ambassador Angelique Kidjo and participants from various civil society organizations.

In Ouagadougou activities planned include a parade of hope by People Living with HIV and HIV, and a campaign to promote prevention of HIV among young people, while in Khartoum high level advocacy and public sensitization programmes have been put in place.

Apart from the four regional launches, national events are taking place in 46
African countries, involving the key decision makers, local communities and other relevant stakeholders. The overall goal of the campaign is to intensify HIV prevention acceleration on the Continent, and build a powerful political and social movement that can finally reverse and stop the spread of HIV which claimed 2.4 million African lives in 2005 alone.

Since the epidemic broke out in the 1980s, 50 million people in Africa have been infected, and 22 million have died; infant mortality, which had fallen by 50% between 1960 and 1990, is on the rise again. Life expectancy in some countries in the region has plummeted to 32 years; overall GDP in one country in the region has dropped to 1%, and agricultural production in another is projected to drop to 24 % by 2010. Africa currently has about 12 million AIDS orphans, and this could rise to 19 million by 2010. An estimated 3.2 million or 64% of the five million new infections globally occur in Africa, with women and children accounting for nearly half of these.

This alarming situation provides a strong justification for acceleration of HIV prevention on the Continent. In November 2005, seven UN agencies operating in Africa met in Brazzaville and adopted the Brazzaville Commitment in which they agreed to ensure synergy in implementing a joint regional plan to support acceleration of HIV prevention, including milestones for 2006 and mechanisms for monitoring the implementation of the plan. This resolution is in line with the Declaration and Road Map towards Universal Access adopted by the Second Session of the AU Conference of Ministers of Health in Gaborone in 2006.

53 African countries meet in Brazzaville to discuss scaling up of HIV prevention

Wed, 08 Mar 2006 22:01:37 PST

( from http://www.rxpgnews.com ) Two hundred and fifty-nine participants from 53 African countries, representing governments, parliamentarians, national AIDS councils, faith-based organizations and civil society organizations, including people living with HIV, and development partners are gathered in Brazzaville, Republic of Congo, for a continent-wide consultative meeting on scaling up HIV prevention, treatment, care and support in Africa towards Universal Access. Eight country delegations are headed by their respective ministers of health.

Hosted by the Republic of Congo, present Chair of the African Union, the consultation is convened by the African Union Commission in cooperation with UNAIDS and the World Health Organization (WHO). The meeting provides a platform for stakeholders to clarify and prioritize the major challenges and obstacles blocking comprehensive and integrated scaling up of prevention, treatment care and support services. It will also explore practical ways of overcoming these obstacles identified in Africa.

In her opening statement at the meeting, the African Union Commissioner for Social Affairs, Adv. Bience Gawanas, stated that it was imperative that Africa develop a common position on Universal Access based on its understanding and experiences.

Michel Sidibe, Director of UNAIDS Country and Regional Support Department and Co-chair of the Global Steering Committee on Scaling up towards Universal Access, stated that the worldwide movement towards Universal Access aimed to achieve a renewed global commitment that no longer seeks to contain the epidemic, but to halt and reverse its progress.

In his statement, the WHO Regional Director for Africa, Dr Luis Sambo, insisted on the vital necessity of giving as much weight to prevention as to treatment, care and support in HIV programmes, pointing out that African ministers of health had already given universal access in Africa a boost by declaring 2006 the Year for Acceleration of HIV prevention in the African Region. He added that the 3 by 5 initiative had highlighted the improtance of using existing opportunities and health infrastructure to deliver atiretroviral therapy and scale up HIV prevention even in resource-limited settings.

Dr Sambo also stressed the need to focus more attention on the vulnerable segments of the population, particularly women and children.

Between December 2005 and February 2006, national consultations were successfully conducted in 41 countries in Africa: 17 countries out of 20 in the Eastern and Southern Africa sub regions, 20 out of 25 in West and Central Africa, 4 out of 7 in the Middle East and the North African subregion. An estimated 5000 country-level stakeholders participated, including community-based organizations, civil society groups, and people living with HIV.

The Brazzaville consultation is discussing key issues related to scaling up towards Universal Access including: how best to combat the stigma, discrimination and gender imbalance that make the lives of people living with HIV so difficult; how Africa will sustain financially its HIV programmes over a long period; how it will ensure sufficient human resources, of good quality, operating in efficient health and social systems; how it will ensure access of all Africans who need them to affordable commodities and low-cost technology, including the male and female condom and inexpensive anti-retrovirals; and mechanisms for holding all stakeholders accountable for their commitments.

The outcome of the consultation will be presented at the African Union Special Summit scheduled to take place in Abuja, Nigeria, in May and will constitute Africas contribution to the 2006 United Nations Summit on AIDS in June.

Impact on child mortality of removing user fees in Africa

Thu, 06 Oct 2005 21:47:38 PST

( from http://www.rxpgnews.com ) User fees are in place in most sub-Saharan African countries. They were introduced to tackle severe under-funding, but evidence shows that such fees do not generate much revenue, are unlikely to improve efficiency, and disproportionately affect poor people.

Using a simulation model, researchers in London analysed how many child deaths might be prevented if user fees were removed in 20 African countries.

They calculated that elimination of user fees could have an immediate and substantial impact on child mortality, preventing an estimated 233,000 deaths annually in children aged under 5 in 20 African countries (estimate range 153,000-305,000). This amounts to 6.3% of deaths in children under 5 in these countries.

Most of these lives would be saved by increased use of simple curative interventions, such as antimalarials and antibiotics combating dysentery and pneumonia, say the authors.

However, they stress that these gains will only be sustainable if policy makers establish viable alternative financing mechanisms, which also account for increased demand for services.

Replacing user fees with more equitable financing methods should be seen as an effective first step towards improving childrens access to healthcare services and achieving the millennium development goals for health, they conclude.

But in another article, Lucy Gilson and colleagues from South Africa warn that removing user fees must be carefully managed to avoid negative impacts on the wider health system. Fee removal must be accompanied by increased national budgets for health care to protect the quality of health care in the face of increased utilisation, they write.

And they also emphasise the need to engage key groups such as health workers in the implementation of this policy change.

HIV/AIDS trials under-represented in sub-Saharan research

Thu, 06 Oct 2005 21:47:38 PST

( from http://www.rxpgnews.com ) A study in BMJ confirms previous findings that HIV/AIDS trials are under-represented in sub-Saharan research and suggests that publication of trial results continues to be driven by researchers external to the continent.

The team identified and mapped all randomised controlled trials on HIV and AIDS conducted wholly or partly in Africa and reported before 2004.

After extensive searching, they identified 77 trials published or reported from 1987 to 2003. Most of the trials were funded by government agencies outside Africa, pharmaceutical companies and international non-government or inter-government organisations. Few principal investigators were based in African countries and there was no mention of ethical approval or informed consent in 19 and 17 trials, respectively.

The relatively small number of HIV/AIDS trials conducted in Africa is not commensurate with the burden of disease, say the authors. This may reflect a lack of economic ability, political will, or research capacity.

Geographical mapping as an adjunct to prospective trial registration is a useful tool for researchers and decision makers to track existing and future trials, they conclude.

Notable Success in KwaZuluNatal Malaria Crisis

Wed, 05 Oct 2005 04:47:38 PST

( from http://www.rxpgnews.com ) The resurgence of malaria remains a major global concern. Artemisinin-based drugs are increasingly seen as one of the best hopes for, at last, making progress in the battle against malaria. Trials of artemisinin-based combination therapy (ACT) in control programs in Southeast Asia have been very encouraging. However, we need to know whether similar levels of effectiveness are achievable in Africa, where the majority of the world's cases of malaria are found.

One part of Africa that has seen increases both in the number of malaria cases and in drug resistance is South Africa's KwaZuluNatal province. The rise in malaria in this area has been dramatic, with a 15fold increase in cases taking place during the 1990s. Control efforts during this period involved mosquito control with pyrethroid insecticides (which had replaced DDT) and sulfadoxine-pyrimethamine (SP) as a first-line treatment. (SP was introduced in 1988 in response to high levels of chloroquine resistance.)

In the year 2000, new measures were put in place to address KwaZuluNatal's malaria crisis. The key elements of this new strategy were the introduction of an ACT drug, artemether-lumefantrine (AL), and an intensification of mosquito control efforts. While pyrethroids were retained for indoor residual spraying of western-style structures, DDT was also reintroduced for spraying traditional homesteads. Karen Barnes and colleagues now present the first comprehensive description and evaluation of the program.

The researchers reviewed four years of malaria morbidity and mortality data at four representative health-care facilities within KwaZuluNatal's malaria-endemic area. They found that, in the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths declined by 89%, and outpatient visits decreased by 85%. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a marked and sustained decline in malaria throughout the province. AL cured 99% of those study patients who were followed up for 42 days. Consistent with the findings of focus group discussions, a household survey found that self-reported adherence to the six-dose AL regimen was 96%. Two surveys in subsets of patients receiving AL revealed no serious adverse events resulting from the treatment.

These are impressive results, but they are not solely due to the introduction of ACT. As the authors say, the ready access to treatment in a relatively well-developed rural primary health-care infrastructure, coupled with an effective vector control programme [are] important factors for deriving the greatest benefit from ACT implementation. Equally important are the strong community perceptions that malaria diagnosis and treatment should be sought urgently at public health-care facilities and treatment then completed.

91 per cent drop in Measles cases in Africa

Thu, 08 Sep 2005 01:13:38 PST

( from http://www.rxpgnews.com ) The studys authors compared disease surveillance data from before and after measles immunization campaigns conducted in the 19 countries from 2000 to June 2003. These campaigns targeted 82.1 million children; reported vaccination coverage was 85% or higher for all of them. Prior to the campaigns, these countries reported an average total of more than 164,000 measles cases. In 2003, after the campaigns, these same countries reported a total of only 15,619 cases.

One of the clearest messages from this study is that with the right strategies, a strong partnership of committed organizations, and the investment of sufficient resources, you can rapidly reduce child deaths in Africa, said Dr. Mac Otten, medical epidemiologist at the Centers for Disease Control and Prevention (CDC), and lead author of the study. A big reason for this success is the support from the Measles Initiative.

The Measles Initiative -- a public-private partnership spearheaded by the American Red Cross, WHO, CDC, the United Nations Foundation, UNICEF, and the International Federation of Red Cross and Red Crescent Societies -- provided technical assistance and funding for measles immunization campaigns in 12 countries in western and eastern Africa (i.e., Benin, Burkina Faso, Burundi, Cameroon, Ghana, Kenya, Mali, Rwanda, Senegal, Tanzania, Togo, and Zambia). Campaigns in these countries targeted children 9 months to 14 years of age. Ninety-five percent (95%) of the 90,000 measles deaths prevented in 2003 were from the 12 countries supported by the Measles Initiative. Seven additional countries in southern Africa held follow-up immunization campaigns in 2000-2003, targeting only children 9 months to 5 years of age.

The Measles Initiative is a model for public health partnerships, said Senator Timothy E. Wirth, President of the United Nations Foundation. The Initiative members work closely with Ministries of Health to plan, implement, and evaluate immunization campaigns. This data demonstrates just how effective this collaboration has been.

Measles immunization provided through routine services confers protection for millions and also contributed to the reduction in cases. Routine coverage increased slightly from 2000 to 2003 in 12 of the 19 countries, while remaining stable in the remaining seven. Improving routine immunization and providing a second opportunity for measles vaccination during an immunization campaign are key measles control strategies in the WHO African Region. Case management and disease surveillance are also essential components for controlling measles.

These are tried and tested strategies that have worked with remarkable results in many parts of the world, said Dr. Jean-Marie Okwo-Bele, Director of the Immunization, Vaccines and Biologicals Department, WHO. But making this a reality in Africa has been particularly challenging given the limitation of the health systems in several countries.

The total donor costs for the measles immunization campaigns in the 19 countries were $68.1 million USD. From the donors perspective, the cost per child targeted was 83 cents and the cost per death averted was $224.

Immunization against measles is one of the most cost-effective public health interventions, said Dr. Mark Grabowsky, Senior Technical Advisor, American Red Cross, and one of the studys authors. Yet, while in the developed world measles has been virtually eliminated, in the developing world the virus still infects millions. Measles often results in severe complications, including blindness, pneumonia, and encephalitis, and kills hundreds of thousands of children each year. For less than $1.00 per child, all of this can be averted.

Its the most vulnerable children who die from measles, said Dr. Peter Salama, Chief of UNICEFs immunization program. Among malnourished children and children displaced through conflict, the death rate from measles can be as high as 25%. If we are going to dramatically decrease child deaths from measles, these strategies must be expanded to protect the lives of the poorest and most under-served children who have not yet been reached with this life-saving vaccine.

The decline in measles deaths represents substantial progress toward the global goal of 50% reduction in measles deaths from 1999 to 2005. Global measles mortality data from 2003 (the most current available) shows that measles deaths have dropped 39% worldwide since 1999, from an estimated 873,000 to 530,000. Global measles mortality data from 2004 is expected by years end.

Discriminatory Attitudes of Health Workers against People Living with HIV

Tue, 19 Jul 2005 14:01:38 PST

( from http://www.rxpgnews.com ) Anecdotal evidence suggests that health-care professionals in Nigeria may discriminate against and stigmatise people living with HIV/AIDS(PLWA). In a study in the August issue of PLoS Medicine, Reis and colleagues set out to characterise the nature and extent of discriminatory practices and attitudes in the health sector, and indicate possible contributing factors and intervention strategies [1]. The study was specifically designed to answer three research questions: (1) are there discriminatory practices in the health sector that affect the health and well-being of PLWA in Nigeria, (2) how receptive are health workers and institutions to treating PLWA, and (3) what underlying factors may contribute to any discriminatory practices?

In order to answer these questions, a representative sample of 1,103 health-care professionals (doctors, nurses, and midwives) working directly with patients with HIV/AIDS were selected from four states in Nigeria and asked to participate in a study. The response rate was 93% (i.e., 1,021 surveyed professionals participated). A survey questionnaire was administered to respondents to collect information about their knowledge, attitudes, and behaviour. The study was reviewed and approved by an independent ethics review board of individuals with expertise in clinical medicine, public health, bioethics, and international HIV/AIDS and human rights research.

Main Findings of the Study

The results suggest that some health-care professionals discriminate against and stigmatise PLWA. For instance, 9% of professionals reported refusing to care for a patient with HIV/AIDS, and 9% reported that they refused a patient with HIV/AIDS admission to hospital. Two-thirds reported observing other health professionals refusing to care for a patient with HIV/AIDS, and 43% observed others refusing a patient with HIV/AIDS admission to hospital.

The study suggests that a significant number of health-care professionals engage in discriminatory and unethical behaviour. Some professionals reported giving confidential information to other people (family members and unrelated individuals) without the patient's consent. Despite these discriminatory attitudes, an optimistic finding is that most health-care professionals expressed an interest in additional information and suggested education and counselling as a way to address discriminatory behaviours by their colleagues.

Myths and misconceptions about HIV transmission play a role in promoting discrimination.

The study concludes that all clinical staff should be educated about HIV/AIDS, modes of transmission of the virus, universal precautions, and the rights of PLWA. Such education is likely to reduce discriminatory practices towards PLWA and may improve these patients' care and access to health services. The study also asserts that a lack of protective materials and other materials needed to treat and prevent the spread of HIV, documented in several health facilities and reported by professionals themselves, contributes to discriminatory behaviour among health professionals.

Implications of the Study

The study raises the possibility (although does not prove) that patients with HIV/AIDS may not fully utilise health-care services because they are denied access by health-care providers who discriminate against them. The fact that some health workers have discriminated against PLWA in the past suggests that health-care professionals serving PLWA should urgently be educated about HIV/AIDS so that they fully understand how HIV can and cannot be transmitted.

It is clear from Reis and colleagues' study and others, including my own research in Botswana [24], that myths and misconceptions about how HIV can and cannot be transmitted play an important role in promoting discrimination. The implication of these findings is clearthere is a dire need to strengthen the information, education, and communication component of HIV/AIDS prevention efforts in order to dispel misconceptions that people tend to hold.

In my own research in Botswana, I found that although the prevalence of discriminatory attitudes towards PLWA may be high, respondents tend to be less discriminating when the HIV-positive person happens to be a family member [2]. People are reluctant to make the serostatus of their relatives public when their relatives are HIV positive, for fear of discrimination.

In order to further our understanding of the root causes of discrimination and stigmatisation of PLWA, qualitative research is needed to understand cognitive processes that lead one to discriminate. It would also be interesting to investigate how PLWA feel that they are perceived by people around them. In order to adequately address issues of discrimination, we must involve PLWA and find out what they feel needs to be done to address stigma and discrimination. We also need to investigate the extent to which researchers are able to measure what they purport to measure with the current indicators of discrimination and stigmatisation. It is possible that the prevalence of stigma and discrimination against PLWA is not being adequately measured with the research instruments currently in use.

References

1. Reis C, Amowitz LL, Heisler M, Moreland RS, Mafeni JO et al. (2005) Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med 2: e246 DOI: 10.1371/journal.pmed.0020246. Find this article online
2. Letamo G (2003) Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana. J Health Popul Nutr 21: 347356. Find this article online
3. Letamo G (2004) HIV/AIDS-related stigma and discrimination among adolescents in Botswana. Afr Popul Stud 19: 191203. Find this article online
4. Letamo G (2005) Gender dimensions in misconceptions about HIV/AIDS prevention and transmission in Botswana [poster]. 25th International Union for the Scientific Study in Population Conference; 2005 1823 July; Tours, France.

WHO appoints Dr Pascoal Mocumbi as Goodwill Ambassador for maternal mortality reduction in the African Region

Mon, 04 Jul 2005 22:36:38 PST

( from http://www.rxpgnews.com ) The World Health Organization Regional Office for Africa (WHO/AFRO) has appointed Dr Pascal Mocumbi of Mozambique as the Goodwill Ambassador for maternal, newborn and child health, with special attention to mortality reduction, in the WHO African Region.

As Goodwill Ambassador, he will serve as the voice of millions of voiceless African women, newborns and children by exploring various mechanisms for the promotion of their health, advocating with governments, communities, philanthropists, philanthropic organizations and foundations to mobilize funds to promote maternal, newborn and child health, including the adoption of the Road map for accelerating the attainment of the MDGs relating to maternal and newborn health by countries.

A former Prime Minister, minister of health and minister of foreign affairs of his country, Dr Mocumbi is credited with restructuring and rationalizing Mozambiques health care delivery system to a level that is now recognized regionally and globally as a best practice. Confronted, as health minister, with limited resources for maternal and newborn health in Mozambique, he initiated a career of maternal and child health nurses and conceived a programme of training and deploying non-physicians such as nurses and medical assistants to undertake life-saving activities such as emergency obstetric care necessary to reduce maternal mortality.

Widely respected both at home and abroad, WHO/AFROs new Goodwill Ambassador for maternal, newborn and child health has extensive experience in both clinical work and evidence-based health management in limited resource settings.

He currently serves as the High Representative of the European and Developing Countries Clinical Trials Partnership (EDCTP) based in The Hague, The Netherlands. EDCTP aims to accelerate the development of new clinical interventions to fight HIV/AIDS, tuberculosis and malaria, particularly in sub-Saharan Africa.

Dr Mocumbi, whose professional association with WHO spans over two decades, also brings to his new assignment experience as a member of the Board of the International Womens Health Coalition, a Patron of the United Nations Commission on HIV/AIDS and Governance in Africa, member of the Coordinating Committee of the Global HIV Vaccine Initiative and Medicines for Malaria Venture. .

His principal briefs as Goodwill Ambassador for maternal, newborn and child health in the African Region are to step up advocacy and resource mobilization for accelerating the attainment of the Millennium Development Goals related to maternal and newborn health in the region.

Specifically, he will:

· Raise awareness of maternal, newborn and child health issues among target groups e.g. Heads of State, policy-makers, development partners and community leaders

· Organize and undertake targeted activities with NGOs, parliamentarians, national and professional womens bodies and associations, the private sector and international organizations

· Engage the media and utilize occasions such as Mothers Day to promote womens and childrens health and disseminate relevant WHO material for promoting maternal, newborn and child health, and

· Facilitate fund raising by stakeholders for improved maternal, newborn and child health

In a note of consent and acceptance to the WHO Regional Director for Africa, Dr Luis Sambo, Dr Mocumbi said: This is a challenge I accept knowing that I will benefit from your enlightened guidance and assistance of the WHO Regional Office for Africa.

Road Map to Intensify Action Against TB in Africa

Wed, 04 May 2005 18:21:38 PST

( from http://www.rxpgnews.com ) At a groundbreaking meeting of the global Stop TB Partnership today, leading African and international health and development officials unveiled a detailed "Road Map" to halt Africa's spiraling epidemic of tuberculosis, which in combination with HIV is overwhelming many health services in the region.

Describing Africa as "the battleground for reaching the global Millennium Development Goals (MDGs) for TB", the Road Map calls for establishing an African Stop TB Partnership to build greater political commitment by governments to fight the disease, and for the African Union and NEPAD to mainstream TB control into the region's health and development agenda.

The Road Map estimates that $1.1 billion will be needed in 2006-2007 to strengthen TB programmes and scale up measures to address HIV-associated TB in Africa. "More than ever before, African leadership is highly committed to health development, in particular to the triad of HIV/AIDS, tuberculosis and malaria," said Dr. Luis Gomes Sambo, the World Health Organization (WHO) Regional Director for Africa. "But more attention needs to be paid to increasing and sustaining resources to scale up field interventions if the Millennium Development Goals are to be achieved." According to WHO, TB incidence rates have tripled since 1990 in 21 African countries with high levels of HIV.

Of the 15 countries in the world with the highest TB rates today, 13 are in Africa. As a consequence, 2.4 million Africans now fall ill with tuberculosis and 540,000 people die from it every year -- a devastating toll that continues to rise by 3-4% annually. The economic toll from the disease is equally devastating. A joint report by the African Union, the Economic Commission for Africa, UNAIDS and WHO in 2004 estimated annual losses of 4-7% in Gross Domestic Product (GDP) due to TB in high burden countries.

The recent report of the Commission for Africa highlighted tuberculosis by linking TB control to strengthening health systems and called for full funding of WHO's "Two Diseases, One Patient" strategy to fight HIV-associated TB. "The challenge that TB and TB-HIV pose to African countries is enormous, and we need enormous resources in terms of funding, drugs and technical assistance to address it effectively, said Prof. Francis Omaswa, Director General of Health in Uganda and a Stop TB Board member. "But it is equally vital that governments show leadership and commitment in order to convert these resources into effective TB treatment for the millions of African citizens who need it." Over the last decade, DOTS* programmes have diagnosed and treated millions of TB patients in Africa, and the results are actually remarkable in some countries given their levels of poverty.

A good example is Ethiopia, which has an annual Gross Domestic Product per capita of $100 and TB cure rates comparable with countries that are 30 times richer. But performance of the region's TB programmes is limited by the impact of HIV and by persistent health system constraints, especially the lack of sufficient trained health staff. In sub-Saharan Africa there is only about 1 health worker per 1,000 population, compared to a global average of 4.

The Road Map builds on the recommendations made by the African Union, UNECA, UNAIDS and WHO in their 2004 report on response to the HIV/AIDS, TB and malaria epidemics. It seeks to realize opportunities for improved regional cooperation for development through NEPAD, increased financing from various multilateral and bilateral sources, and broader engagement of patient and community activists.

Among the main elements of the road map:
establishment of an African Stop TB Partnership to mainstream TB into the agendas of the African Union and NEPAD and strengthen health systems;
rapid support to improve quality of TB diagnosis and treatment;
scale up of interventions to ensure that HIV-infected persons are screened and treated for TB, and HIV-infected TB patients are among the candidates for anti-retroviral therapy;
involvement of NGOs, private health providers and communities to expand access to TB diagnosis and treatment; and
large-scale communication campaigns to mobilize communities, dispel stigma and increase awareness that TB treatment saves lives and can reverse the epidemic