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World Vs TB: The Fight Continues

Today let us take cognizance of yet another disease that has besieged mankind for literally forever and every now and then rigorous drive, campaigns and high-level meetings are organised to heighten its prevalence and to educate and aware the masses. 

Like the ubiquitous virus that has enveloped our lives, thoughts with its looming uncertainties, tuberculosis (TB) has affected mankind for more than 4,000 years. It is a chronic disease caused by the bacillus Mycobacterium tuberculosis and spreads from person to person through the air. Surprisingly, this doesn’t surprise us. Why? Because not enough attention is given to the grim scenario precursing TB. 

TB usually affects the lungs but it can also affect other parts of the body, such as the brain, intestines, kidneys, or spine. Symptoms of TB depend on where in the body the TB bacteria are growing. In the cases of pulmonary TB, it may cause symptoms, such as chronic cough, pain in the chest, haemoptysis, weakness or fatigue, weight loss, fever, and night sweats.

Tuberculosis remains one of the leading infectious killers globally, and the leading cause of death among people living with HIV. Despite being a preventable, treatable and curable disease, TB kills more than 1.4 million people each year and affects millions more, with enormous impacts on families and communities.

Ending this debilitating disease remains a priority for the World Health Organisation (WHO). More than 20 million people received access to TB services over the past 2 years, almost 5 million more than the previous 2 years. 109 countries have started using new effective TB drugs, while 89 countries reported using better and faster treatments for multidrug-resistant TB, in line with updated WHO treatment guidelines.

The outburst of the COVID-19 pandemic has put these accretions at risk and has severely disrupted the services, adding TB patients into a more vulnerable condition with increased risk. Pandemic response pushed aside tuberculosis outreach and services, resulting in a 20% drop in diagnosis and treatment worldwide, urgent recovery needed, stated the Stop TB Partnership.

The latest data of Stop TB Partnership shared reflected that nine of the countries with the most tuberculosis (TB) cases — representing 60% of the global TB burden — saw a drastic decline in diagnosis and treatment of TB infections in 2020, ranging from 16%-41% (with an average of 23%). The drop brought the overall number of people diagnosed and treated for TB in those countries to 2008 levels, a setback of 12 years.

An estimated 1.4 million fewer people received care for TB last year — 21% less than in 2019. This disruption could cause an additional half a million deaths, according to WHO. 

Unlike Covid, the tuberculosis strategy doesn’t include a vaccine. However, it includes tools to prevent people at high risk of TB from developing the disease. This incorporates preventive treatment, which reduces the risk of disease by up to 90% and can provide years of protection against both TB and the risk of premature death for people with HIV. It can also prevent hospital visits and protect families and communities against catastrophic costs.

The lack of awareness hints towards the careless attitude which can be discerned from the ineffective use of these tools. However, the numbers of people receiving this life-saving intervention have quadrupled since 2015, it’s not enough and needs more and more engagement. 

In 2018, Member States at the UN High-Level Meeting on Tuberculosis made bold commitments to provide TB preventive treatment to at least 30 million people by 2022. This included 24 million contacts of people with TB, and 6 million people living with HIV.

India’s combat strategy

Addressing the WHO Global Tuberculosis Programme on ‘Global Drive to Scale-up TB Prevention’ on India’s commitments to enhance TB prevention, Dr Harsh Vardhan said, “Scaling up TB preventive treatment is of utmost importance to break the chain of transmission and prevent the breakdown of those with TB infection into full-blown active TB disease. India is embarking on a new TB preventive treatment to combat and end TB by 2025.”

Affirming the country’s commitments, the Union Health Minister said that India is aggressively implementing its fully-funded National Strategic Plan to End TB. Phenomenal work has been done in the last few years by treating 50 million people. India also stands committed to rapidly achieve national scale-up of TB preventive treatment (TPT) and activities to achieve the UN High-Level Meeting (UNHLM) targets of 40 million persons started on TB treatment and 30 million on TPT globally in the remaining 18 months.

Way ahead: Commitments to fulfil

To achieve the ambitious commitment firstly, we need to scale up preventive treatment for household contacts of people with TB, including children, alongside efforts to find people with TB disease among people living with HIV. We must pay special attention to settings with a high prevalence of undetected TB, such as informal settlements and prisons. Second, we must call on Ministries of Health to scale up access to primary health care and community-based services to reach the household of every TB patient.

This will also require investments in WHO-recommended technologies to screen, test and provide care for affected households.

And third, all stakeholders need to work together to build the capacity of health workers and health systems on the use of TB preventive treatment, and to overcome hesitancy.

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