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is dicult to diagnose and treat, and the quoted gures are probably underestimates. Only 16% of patients with multidrug-resistant tuberculosis are thought to be undergoing treatment. Donor funding of about $600 million for tuberculosis control is expected in 2012, which Lucica Ditiu, executive secretary of the Stop TB Partnership, argues is completely inadequate and almost $15 billion short, when you consider that the funding gap for meeting the 2012 implementation targets of the Global Plan to Stop TB remains $2 billion. Although more than 80% of this donor funding is provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria, comparative gures for malaria ($18 billion in 2009) and HIV/AIDS ($69 billion in 2010) suggest that tuberculosis programmes have struggled to attract external support. Across the 22 countries with high burdens of tuberculosis, domestic money will contribute about 87% of future funding, reecting growing but uneven economic successand emphasising the continued imperative for targeted funding for tuberculosis activities in high-burden countries. What of future prospects for improvements in disease diagnosis and treatment? WHO has endorsed Xpert MTB/RIF, a rapid diagnostic test for Mycobacterium tuberculosis that is currently being rolled out. Although existing drug treatments for tuberculosis are cumbersome and protracted, especially in multidrug-resistant disease, several drug candidates are in development. Substitutions of rifapentine, gatioxacin, or moxioxacin into existing regimens have advanced to phase 3 trials, while the new agents bedaquiline and delamanid are undergoing phase 2b trials in multidrug-resistant tuberculosis. Of the candidates for new vaccines against tuberculosis to supersede or provide an alternative to BCG, the most advanced are three vaccines in phase 2b trials, which implies that no new vaccine can be licensed before 2018. In a Comment in todays Lancet, Salmaan Keshavjee and colleagues call for a startling global target of zero deaths from tuberculosis. Successes in disease control in China and other countries show what sustained political and economic support can achieve. Rather than waiting for the elixir of economic success to arrive in all high-burden countries, committed action by donors, agencies, and governments in the most challenging settings is needed in the global campaign against tuberculosis. The Lancet
For the WHO report on global tuberculosis control see http:// www.who.int/tb/publications/ global_report/en/index.html
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