The COVID-19 pandemic has created a seismic upheaval in global health care and individual health testing and treatment. Previous gains in reducing life-threatening chronic diseases are being eroded by the need to turn attention and resources to the pandemic. It feels like a “Snakes and Ladders” board game: The counter has landed on the head of a snake and programs for other diseases have slid to the bottom of the board, landing many years behind.
The global health community is concerned that tuberculosis (TB) continues to disproportionately kill people living with HIV, despite the availability of TB preventive therapy. According to the World Health Organization’s Global Tuberculosis Report 2019, deaths attributed to TB among people living with HIV account for 17 percent of all TB deaths, even though people living with HIV account for only 8.6 percent of overall TB cases.
Tuberculosis (TB) has now overtaken HIV as the world’s leading cause of mortality. There were about 10.4 million TB cases in 2016, despite the fact that TB is an old and often curable disease whose incidence declined in industrialized countries long before the introduction of the TB vaccine and anti-TB drugs. TB continues to disproportionately affect low-income countries. For those of us who work in public health, this is tragic — we ought to be moving forward at a much faster pace to end TB for good.
A version of this post originally appeared on FHI 360’s R&E Search for Evidence blog.
Tuberculosis (TB), which in 2016 killed an estimated 1.7 million people, is an ancient disease found in the bones of mummies dug up from Peru. It has evolved with humans, and like other successful organisms, finds ways to avoid death, so it can thrive and spread to the next person. Trying to get ahead of this successful adversary requires pursuing a consistent, aggressive research agenda aided by international collaboration.
World TB Day 2016 comes at a watershed time in the history of the tuberculosis (TB) epidemic and the broader global response to health and development. In recent years, we have expanded access to more sensitive TB diagnostic services, increased awareness about the important role of infection control within health care settings and have new treatment options for individuals with multidrug-resistant (MDR) TB. But, there is much work still to be done.
TB now rivals HIV as the top global infectious disease, yet we have not applied the same vigor to controlling TB as we have to controlling the HIV epidemic. That time is no longer. We have the opportunity to mirror the advances gained toward ending the HIV epidemic, largely based on evidence, driven by ambitious targets and linked to well-designed guidance.
In many parts of the world, HIV poses a particular challenge to TB control, which we cannot ignore. We have developed HIV prevention and treatment tools that will allow us to end the HIV epidemic, and we must add urgency to align these with TB control efforts. Doing so will assure successful outcomes in the fight against HIV and TB coinfection. The urgency comes from World Health Organization reporting that indicates mortality from TB eclipses mortality from HIV. The tremendous research and program advances from unprecedented investments in the HIV response must be leveraged to take control of TB morbidity and mortality.
This moment in time is particularly important as we transition to the Sustainable Development Goals (SDGs) that will guide policy and funding over the next 15 years and are linked to a pledge to end poverty, everywhere, permanently. While health is now only one of 17 goals, the shift in focus may bode well for control of TB, which is a disease of poverty exacerbated by malnutrition, overcrowding and poor hygiene.
FHI 360’s TB initiatives strategically align with the SDGs. Our projects provide technical assistance to governments to yield evidence-based solutions to their local TB situations. We assist governments with improved disease surveillance so they can invest in ways that will yield the greatest impact by providing curative treatment and limiting new infections. We promote an approach that focuses on those most vulnerable in society because TB concentrates in the most marginalized populations of any given society. A human rights-based approach that engages affected communities is the basis for a sound, effective response.
FHI 360’s Deputy Country Director for Nigeria, Dr. Robert Chiegil, spoke with Voice of America’s health correspondent Linord Moudou yesterday about reducing the impact of HIV and TB in Nigeria and other African countries. Watch the video below.
The global resurgence of tuberculosis (TB) over the past decades has been fueled by emerging drug resistance, co-infection with increasingly prevalent HIV and decreasing investments in public health systems. These challenges call for innovative, strategic approaches and more efficient, cost-effective programs. TB CARE I is a coalition of seven international TB control organizations, each with offices in most of the TB-priority countries for the U.S. Agency for International Development (USAID).
FHI 360 is the lead coordinating partner in Cambodia, Mozambique and Zambia and a collaborating partner in Indonesia and Nigeria. The program focuses on specific technical areas, including early case detection, improved laboratory capacity, management of drug-resistant TB, HIV/TB co-infection and health systems strengthening. FHI 360 and TB CARE I assist countries to move toward universal access to TB treatment by working with communities most at risk to reduce morbidity and mortality through increased case detection and treatment.
The three videos below produced by TB CARE I are great visual portrayals of how TB has affected lives in Cambodia and the Dominican Republic. Visit TB CARE I’s website to see other videos like these, and to learn more about the project.
Multidrug-Resistant TB or MDR-TB is a serious form of TB which is resistant to at least the two most powerful TB drugs. As MDR-TB is difficult to cure, it requires treatment for a minimum of 20 months with drugs which often have severe side-effects. In this video Yim Chann (Cambodia) will tell you about his triumph over MDR-TB
Greetings to all! I recently had the opportunity to work with colleagues from FHI 360 and the National Tuberculosis Program (NTP) and National AIDS Program (NAP) in Indonesia. FHI 360 is a collaborating partner for USAID-sponsored work in Indonesia under the project called TB CARE I. We work with the Dutch organization KNCV, the World Health Organization and others to focus on integrating tuberculosis (TB) and HIV/AIDS activities and to improve access to TB care and treatment within prisons across that large and complex country.
Why are we at FHI 360 so focused on TB-HIV/AIDS integration? For a number of years, we have been working with governments to build stronger HIV/AIDS programs around the globe. What we and others have learned is that the number-one killer of people living with HIV/AIDS is TB. There is a very close, causal link between TB and HIV/AIDS. HIV/AIDS makes it many times more likely that a person will get sick with or die from TB. In addition, TB makes the HIV/AIDS virus replicate even more quickly, leading to further immune suppression and AIDS-related illness and death. Recent published research has shown that life-saving interventions include rapid initiation of TB treatment after diagnosis and rapid initiation of antiretroviral therapy (ART) after TB treatment gets started. Furthermore, isoniazid preventive treatment (IPT) can save lives by keeping people with HIV/AIDS from getting TB. An even more powerful approach for individuals already infected with the HIV virus is to get them started on ART before their immune systems become too weak.
In addition to my key objective of reviewing our TB-HIV/AIDS activities and the prison program, I served as a plenary speaker at the Indonesia Infectious Diseases Update Symposium in Malang, Indonesia. I also provided lectures and on-site consultation for members of the NTP, NAP and FHI 360 staff, focusing on multi-drug resistant TB, TB-HIV/AIDS and IPT. Our discussions showed how challenging it is to implement good programs with limited resources.
Other TB-related issues are also critical to solve. These include improving universal access to high-quality TB diagnosis and treatment, preventing spread of disease from one person to the next — especially within hospitals and clinics — and identifying and preventing disease among young children, who are at high risk for severe TB. USAID-TB CARE I provides funding to FHI 360 to work on these and related issues in Cambodia, Indonesia, Mozambique, Nigeria and Zambia.
In keeping with the theme for World TB Day 2012, “STOP TB in My Lifetime,” I want to see the epidemic of TB-HIV/AIDS become a distant memory. I am happy to report that my colleagues in Indonesia are working hard to make this come true.
World TB Day is Saturday, March 24, 2012. For more information, please visit the Stop TB Partnership’s World TB Day site.