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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.
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
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
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
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
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.