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108 CHAPTER 5 ■ Tuberculosis: Keys to Success in Peru

There are opportunities for application of all 4Ps in the marketing mix, ones actually
needed to reach these ambitious goals. And there are mechanisms in place to moni-
tor and evaluate progress. This chapter begins with a brief description of the world’s
tuberculosis problem, provides a country overview, and then presents key elements
of a successful marketing effort to reduce the incidence and prevalence of tubercu-
losis in Peru.

TH E W ORL D’S TU B E RCU L OSIS P ROB L E M

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads
through the air. Only people who are sick with TB in their lungs are infectious, but
when these people cough, sneeze, talk, or spit, they propel TB germs, known as
bacilli, into the air. Unfortunately, a person needs only to inhale a small number of
these to then be infected. Left untreated, each person with active TB disease will in-
fect on average between 10 and 15 people every year. But people infected with TB
bacilli will not necessarily become sick with the disease because the immune sys-
tem “walls off” the TB bacilli which, protected by a thick waxy coat, can lie dor-
mant for years. When someone’s immune system is weakened, the chances of
becoming sick are greater (WHO, 2007). Nearly 2 billion people around the world
are infected with the rod-shaped bacterium that causes tuberculosis (WHO, 2007).
This is almost one out of three human beings. If TB disease is detected early and
fully treated, people with the disease quickly become noninfectious and are eventu-
ally cured (WHO, 2008a). Twenty-two countries account for 80% of the TB cases
in the world, with the largest incidence and prevalence of cases in Southeast Asia
and Africa (2005 data; Stop TB Partnership, 2008; WHO, 2007).
In 2006, there were an estimated 9.2 million new cases of TB, including 700,000
cases among people living with HIV, and 500,000 cases of multi-drug-resistant TB
(MDR-TB). An estimated 1.5 million people died from TB in 2006. In addition, an-
other 200,000 people with HIV died from HIV-associated TB (WHO, 2008a).
On March 17, 2008, the World Health Organization (WHO) reported that
worldwide efforts to confront tuberculosis are making progress, but too slowly.
Their Global Tuberculosis Control report (WHO, 2008a) finds that the pace of the
progress to control the tuberculosis epidemic slowed slightly in 2006 (the most re-
cent year for which data were available). The new information documents a slow-
down in progress on diagnosing people with TB, a key strategy to preventing its
spread and increasing treatment. Between 2001 and 2005, the average rate that new
TB cases were detected was increasing by 6% per year. Between 2005 and 2006,
however, that rate of increase was cut in half, to 3%. Moreover, in most African
countries there has been no increase in the detection of TB cases through national