World TB Day 2016: Four Ways to End TB

By Pedro G. Suarez, MD Global Technical Lead, TB Tuberculosis (TB) claims a life every 15 seconds; it is the single largest infectious killer and is universally recognized as a global epidemic. Nearly 200 children die every day of TB. The challenges of tackling TB are well known, particularly in settings with limited resources, crowded urban environments, and among high risk groups including people living with HIV, prisoners, and children. The emergence of multidrug resistant strains of the disease (MDR-TB), the result of incomplete or poor managed TB treatment, present further obstacles and add exponential costs to already burdened health systems. Furthermore, challenges with access to, affordability, and proper use of pharmaceuticals and laboratory materials can have devastating consequences on diagnosis and treatment. The key to ending TB is to work together to strengthen health systems in high TB-burden countries to be able to effectively implement both proven and innovative strategies. Four approaches will help save lives by uniting stakeholders to collaborate, innovate, and end TB: Care and control in urban settings In urban settings, where population density and overcrowding of health facilities has led to higher TB rates than national averages, the introduction of directly observed therapy, short course (DOTS) has proven highly successful to help ministries of health tackle the challenges of TB. The DOTS strategy involves public and private health care providers in TB control efforts and helps to ensure that all presumptive TB patients are screened and initiated on treatment. For example, in Kampala, Uganda, and Kabul, Afghanistan, MSH teams work alongside national TB programs and local stakeholders to train city-based health facility staff to identify individuals with TB symptoms, provide timely TB testing and treatment, supervise patients’ medication intake, and accurately register and report TB-related data. The DOTS strategy helps to ensure that all those on treatment are followed up to cure, helping to reduce the burden on the health system.

2) Detect and treat MDR-TB Another important component to end TB is helping countries expand services for the detection and treatment of MDR-TB. In Ethiopia, for example, the system in place to identify presumptive MDR-TB cases was weak; there were few diagnostic facilities and limited laboratory capacity for culture and drug sensitivity tests. Many patients were on a waiting list for an entire year or longer because there were only three hospitals that were able to admit and initiate treatment for a population of 96 million. Through the USAID-funded Help Ethiopia Address the Low Tuberculosis Performance (HEAL TB) project, MSH supported the Ethiopian Ministry of Health and partners to develop and implement a case notification strategy for MDR-TB in 2185 health facilities. The project has worked to help renovate and expand hospitals and treatment centers, train human resources, and follow and monitor treatment outcomes. HEAL TB has expanded MDR-TB services to serve more than half the Ethiopian population. Watch video: Tuberculosis in Ethiopia 3) Better pharmaceutical management systems and services Central to these efforts is the need for TB medicines to be taken by patients in the correct dosages, for the full prescribed treatment, and while adhering to instructions for appropriate use. Using tools and training developed by MSH through USAID’s Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, countries can identify underlying pharmaceutical management challenges and apply tailored solutions to systematically and effectively manage TB medicine access and safe use. For example, 15 countries now utilize QuanTB to implement early warning systems to prevent stock-outs of TB medicines.  Several countries are increasing TB and MDR-TB case finding by engaging private pharmacies and drug shops, the first point of service for many people in rural settings; Pakistan and Tanzania are seeking to scale up the practice nationwide. Ukraine and others are implementing the e‐TB Manager, a web-based tool for managing information needed by national programs. And Georgia and Swaziland are among countries monitoring the safety of new TB medicines, such as bedaquiline. 4) Prioritize childhood TB When it comes to childhood TB, a programming gap persists between policy and practice -- a gap that can be addressed by focusing on stronger systems and linkages between TB and existing maternal and child health, HIV, and nutrition platforms. TB is not considered a childhood illness, something that MSH and others are working to change. Watch videos: Addressing Childhood Tuberculosis: Opportunities for Maternal and Child Survival Platforms and Louder than TB In commemoration of World TB Day, MSH renews our 30-year and ongoing commitment to battle the world’s oldest disease, especially among the poorest and most vulnerable. By collaborating, innovating, and uniting -- within and across sectors, donors, organizations, countries -- we will save more lives and end TB.