11 minute read
STOP TB Partnership
To end TB, prevent TB
we must
One of the most alarming aspects of The Union’s work to end the global tuberculosis epidemic, is knowing TB is both the leading infectious killer globally and at the same time a very preventable illness.
Tuberculosis is a terrible illness caused by a bacteria that spreads from person to person through the air. Left untreated the disease typically causes a person to lose tremendous amounts of weight and become increasingly short of breath, withering the body to nothing if left untreated.
Through their participation in the United Nations, governments committed to ending the TB epidemic by the year 2030. As we enter the year 2020, however, we are far from reaching that goal. A key part of ending TB is prevention.
We are far from reaching our 2030 goal to end TB We know from data modeling that ending TB is not realistic without much stronger prevention eff orts. We can prevent people from becoming infected with TB, we can prevent people from developing TB disease and we can prevent people dying from TB. Despite having this knowledge, we are not (with some important exceptions) making nearly enough progress as we need to on TB prevention.
According to the World Health Organization, young children especially are missing out on TB prevention. Every child exposed to TB in their household needs TB preventive therapy before they become sick. Yet only one in four such children receives that therapy. People living with HIV (PLHIV) are also eligible for TB preventive therapy, yet half of PLHIV are going without it.
Against this gloomy backdrop, however, there is hope. There is growing recognition that people at risk of TB have a right to know whether they’re living with a TB infection and to make informed decisions about how to safeguard their own health, including through receiving preventive therapy.
PHOTO: VINCENT BECKER
José Luis Castro Executive Director, The Union
Preventative therapy is becoming more straightforward And preventive therapy itself is improving, becoming easier for people to take. Whereas standard therapy used to take nine months, today we’re seeing eff ective preventive options that require taking only one pill weekly for three months, or one pill daily for one month. We’ve also seen a new TB vaccine candidate that could have a signifi cant impact if late-stage testing is successful. It is inexcusable that people are dying from this entirely preventable disease. The Union is committed to doing all that we can to help countries prevent TB. The rationale is simple: to end TB, we must prevent TB.
Polina Kisel, a patient with multidrugresistant TB, with an x-ray photo of her chest in Minsk, Belarus.
In Belarus, 38% of new TB cases in 2018 are drug-resistant, which means a longer, costlier, and more diffi cult treatment for patients like Polina. To stop drug-resistant TB we need better diagnosis, better drugs, and better treatment procedures.
Image and content provided by The Global Fund
Arim’s story...
Arim, a patient with extensively drug-resistant tuberculosis (XDRTB), holds an X-ray of his damaged lungs.
Arim, from Kurdistan, had to go to Jordan to get adequate treatment for his disease.
XDR-TB is particularly complex, and requires prolonged treatment.
Arim has been on a treatment regime for more than two years, and has responded well to new drugs that have become available.
TB
PHOTO: VINCENT BECKER
Image and content provided by The Global Fund
Drug-susceptible TB and XDR TB are spread the same way. TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, shouts, or sings. These bacteria can fl oat in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB bacteria can become infected.
Latent TB is the basis for the world’s deadliest infectious disease – but it can be cured
With almost one third of the world carrying the latent tuberculosis infection, education and research are vital to eradicate the planet’s deadliest infectious disease once and for all. Latent tuberculosis infection (LTBI) is the name for the stage when tuberculosis (TB) bacteria have entered the body, but are lying dormant without causing any symptoms. If they start growing, LTBI will turn into active TB, the world’s deadliest infectious disease, and one of the top 10 causes of death worldwide.
Lucica Ditiu, Executive Director of the STOP TB Partnership, says LTBI is a real danger. “The biggest concern is the scale. A huge number of people are infected globally and, although latent TB is a dormant infection, it has the potential to become active. The biggest threat lies in the fact the numbers we are talking about are so big.” Testing is diffi cult and some countries do not feel the cost is justifi able Around 10% of people with LTBI will develop active TB during their lifetime. However, for some people, including underfi ves and HIV patients or other immune-suppressed groups, the risk is much higher.
However, current testing tools are the best ever available but still challenging to use, requiring blood samples. Rather than a typical, point-of-care testing as saliva or urine samples. On top of this, some country programmes are reluctant to spend money on treating latent infection that has no symptoms and does not represent a public health threat.
Due to a collective push coordinated by Stop TB partnership, the fi rst ever United Nations High-Level Meeting on TB in 2018 saw member states agree that 30 million people should be able to access TB preventive treatment by 2022. Private sector partners have now also joined the fi ght against TB. Education and awareness around latent TB must be improved Patient website www.ltbi.com has recently been launched to support patients with LTBI and educate people on the infection. An e-learning platform* was also launched at the 50th Union World Conference on Lung Health in October 2019 to train clinicians, healthcare workers and national TB programme managers in the successful treatment of LTBI.
“We need to ensure that we are letting people know about this problem,” says Ditiu. “Very few people are aware of TB, so education and the spread of information are important. Very few people are aware of TB, so education and the spread of information are important PHOTO: ATU L LOK E Journalist Meredith Jones-Russell
Image and content provided by The Global Fund
“We also need urgent research to understand much better the basic science on TB - why some people get infected and others do not, why some develop the disease and others do not. If we can fi nd a way to predict who gets infected and, from those infected who gets sick, that will be huge.”
World TB Day, celebrated on 24 March, aims to build public awareness of TB and eff orts to eliminate the disease.
“The more undiagnosed people are left without diagnosis and treatment, the more TB infection we will see,” explains Ditiu. “Country programmes should include comprehensive packages for TB response, including treatment for Latent TB. We must keep in mind that we will never end TB without addressing those infected with TB. “On World TB Day, we hope people outside the TB community will understand more about LTBI and all UNHLM on TB targets, and heads of state will realise their responsibilities and take their commitments seriously.”
Find out more at
www.globalcause.co.uk
A community health worker in the city of Narela, north of Delhi, talks to a group of women as part of an awareness-raising campaign about tuberculosis.
India has the world’s largest TB epidemic.
www.LTBI.com - recently launched global website dedicated to latent TB infection. Its key objectives are to raise awareness of TB prevention and to educate patients and the general public in a simple and accessible way.
*Learn more on courses.theunion.org
Testing and treating TB – the challenges
PHOTO: SARAH HOIBAK
The World Health Organization (WHO) declared tuberculosis (TB) a global emergency 25 years ago, yet TB remains among the top 10 causes of death worldwide and the leading infectious disease killer. TB is preventable and curable, yet millions of people with TB do not have access to aff ordable diagnostic tests and treatment – especially in developing countries.
The WHO estimates that nearly one-quarter of the global population has latent TB infection (LTBI). Unless they receive the right diagnosis and treatment, around 10% of those carrying latent TB infection will develop the contagious form of the disease – continuing the vicious cycle of putting themselves, and those around them in harm’s way and reseeding the pool of tomorrow’s TB with LTBI.
Global experts agree that the solution to ending the global TB epidemic is twopronged. We must detect and treat people with active TB, but also reduce the large reservoir of latent TB infection, to end the cycle of the disease.
The world’s deadliest infectious disease Worldwide, TB is the leading cause of death from a single infectious agent (surpassing even HIV/AIDS). According to the WHO, ”a total of 1.5 million people died from TB in 2018 (including 251,000 people with HIV)”.
“In 2018, an estimated 10 million people fell ill with tuberculosis (TB) worldwide. 5.7 million men, 3.2 million women and 1.1 million children. There were cases in all countries and age groups.”
“In 2018, 1.1 million children fell ill with TB globally, and there were 205,000 child deaths due to TB (including among
children with HIV). Child and adolescent TB is often overlooked by health providers and can be diffi cult to diagnose and treat.” 2 Preventative regimes are much better tolerated by children compared to adults, but, sadly, programmes for children over the age of fi ve who are exposed to TB do not exist in highburden countries and are often poorly implemented for children under age fi ve.
Preventative testing and treatment saves lives The WHO End TB Strategy, launched in 2015, carried a bold vision statement: ”A world free of tuberculosis – zero deaths, disease and suff ering due to tuberculosis”. Can this vision ever be reached?
Although some progress has been made, millions continue to lose their lives to TB. Current TB control measures seem unlikely to meet 2020 and 2025 milestones set out in the End TB Strategy (respectively, a 35% and 75% reduction in TB deaths compared with 2015). 3 Globally, TB incidence is falling at about 2% per year. This needs to accelerate to a 4–5% annual decline to reach the 2020 milestones of the End TB Strategy. 2 However, in September 2018, the fi rst ever UN High-level meeting on TB was held and world leaders agreed that only expanded testing and treatment of latent TB infection can end the
cycle of disease transmission. As a fi rst major international step, they passed the Political Declaration Of The High-Level Meeting Of The United Nations General Assembly On The Fight Against Tuberculosis. 4 Among its key proclamations, it calls for preventive treatment of 30 million persons by 2022, and for international agencies to fund and rapidly scale up the WHO’S End TB Strategy. The Assembly also committed to mobilise suffi cient and sustainable fi nancing for universal access to quality prevention, diagnosis, treatment and care of tuberculosis, from all sources, with the aim of increasing overall global investments for ending tuberculosis and reaching at least 13 billion United States dollars a year by 2022.
Targeted testing and treatment of latent TB People with active TB can infect fi ve to 15 other people, through close contact, over the course of a year. Treatment of LTBI eliminates the bacteria before infection become contagious, preventing spread of the disease. Treatment of the latent infection is also easier, less costly, and less toxic than treating active TB disease.
In 2018, The World Health Organization released new guidelines on the programmatic management of LTBI that harmonised preventative screening and
treatment protocols in countries with high and low TB burden and regardless of country income. In the new guidelines, the WHO 5 : • Finds clear evidence for the benefi t of systematic testing and treatment of LTBI
• Supports IGRA (interferon-gamma release assay) testing globally for at-risk populations
The WHO places emphasis for latent TB testing on high-risk groups, including people living with HIV, household contacts of active TB cases, and patients receiving anti-TNF treatment.
Everyone has the right to know their TB status Treatment regimes are becoming more streamlined, but they remain burdensome. Universal access to aff ordable diagnostics for latent TB will enable at-risk populations to make informed treatment decisions. Accurate TB testing also streamlines care, allowing providers to focus on true positives, reduce unnecessary treatment, and improve programmatic success.
