One-third of the approximately three million people who contract tuberculosis every year in the WHO South-East Asia Region do not get access to TB services.

In a new report released ahead of the World TB Day, the World Health Organisation has urged countries to find, treat and cure the “missing” one million who do not get services so as to accelerate progress towards zero TB deaths, infections, suffering and stigma.

Worldwide, nine million people are afflicted with the disease every year, and about three million with active tuberculosis are not diagnosed and continue to spread the disease in the community, with many dying. Other patients are diagnosed but not officially reported, so they elude public health systems. The consequences of failure to diagnose and properly treat these three million people will nullify the gains made in tuberculosis control.

“Drugs alone cannot beat TB in the community. TB is a condition strongly influenced by low nutrition, poverty, social stigma, environment, rapid urbanisation, and large population displacement in many countries, and these are the factors that result in so many unreported cases,” says Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.

Global burden

Southeast Asia accounts for 39 per cent of the global burden of TB in terms of incidence. India alone accounts for 26 per cent of the world’s TB cases. It is estimated that 3.4 million new cases occur each year and 4,50 000 people died of the disease in 2012, most of them in Bangladesh, India, Indonesia, Myanmar and Thailand.

The WHO South-East Asia Region is on track to achieve the global target of 50 per cent reduction in the rate of deaths due to TB by 2015 (compared with 1990). People’s access to care has expanded substantially in the region, and since 2011, all Member States have continued to enjoy at least 89 per cent treatment success rates. Almost 22 million patients have been treated in the past 10 years.

Owing to good implementation of the directly observed treatment, short course (DOTS), multidrug resistance among the newly detected cases is relatively low in the region. Laboratory networks have been strengthened in all countries to detect infections better.

A comprehensive package of TB-HIV interventions is now available to over 1,500 million people in the region. Intensified case-finding is steadily increasing at TB–HIV counselling and testing and care centres. India, Indonesia, Myanmar and Thailand — the high-burden countries in terms of HIV — have strong and unique TB–HIV referral and integrated management mechanisms.

However, to reach the hard-to-reach populations in need of TB care, the primary health care approach is seen as the most feasible. Public-private initiatives have helped in increased notification of cases. Community-based TB services are expanding and have demonstrated cost-effectiveness, higher utilisation and better outcomes. Social support that entitles TB patients to community-based poverty alleviation schemes positively impacts treatment access as it brings down social and economic barriers.

TB is curable. With the focus on increased community awareness and community engagement, reaching the million in need of treatment will be a major step forward in the ultimate goal of eliminating the disease.