Efforts to expand treatment are yielding results. Yet there are miles to go before the WHO’s target of ending the disease by 2030 can be achieved
A report on the global battle against TB, the world’s most deadly infectious disease, by the World Health Organisation (WHO) says several positive trends are being witnessed worldwide in this fight against the killer.
First, efforts to expand TB treatment are yielding results as in 2018, globally 600,000 more people received treatment than the previous year and deaths due to the disease dropped by more than six per cent.
Second, TB prevention is picking up pace. Substantially more children below the age of five, who are contacts of TB patients, are accessing preventive treatment, with a four per cent rise in 2017 levels. The coverage of People Living with HIV (PLHIV) rose by an impressive 19 per cent.
Third, there have been inroads in the fight against drug resistance, as in 2018, more than 156,000 patients globally with Rifampicin-resistant or multi-drug resistant TB initiated treatment, an increase of almost 12 per cent over the previous year. Treatment success rates for both new and drug-resistant cases continue to improve.
However, challenges persist and drug-resistant TB remains a serious global threat as just one in three people afflicted are getting treatment and major gaps in case notifications remain. An estimated three million patients globally are unaccounted for. Access to preventive treatment is insufficient and just below half the people, newly-enrolled in HIV-care, are receiving preventive therapy. Funding shortfalls continue and in 2019 alone, committed global funds for TB diagnosis and care fell short by $3.3 billion.
The world will struggle to reach the 2020 milestones of WHO’s End TB Strategy. This is of concern given that by 2030 WHO and its member countries and partners aim to end TB, as reflected in the Sustainable Development Goals and the UN’s High-Level Political Declaration on the Fight against TB.
As the world’s most TB-affected region, South-East Asia’s progress is significant, as between 2017-2018 estimated case incidence fell from 226 per 100,000 people to 220 per 100,000. The notification of TB cases increased substantially, from 2.96 million to 3.36 million, with most cases coming from India and Indonesia — a credit to their resolve. Notably, the number of children under five who required preventive TB treatment and accessed it increased by12 per cent. Myanmar was identified as one of a clutch of countries on track to reach the global End TB 2020 milestones.
Though the region’s progress has been strong, more is needed to end TB by 2030. To do that, active case-finding should be intensified. Efforts to engage communities should be stepped up and the private sector encouraged to act.
In particular, community groups should be further empowered, including by engaging them in policy development. Information campaigns should be targeted at high-risk communities and access to TB testing guaranteed. Enhancing the coverage of preventive treatment is crucial. By fully implementing the region’s recently adopted action plan on latent TB, member states can reduce the annual burden of TB patients by an additional 12-15 per cent annually. That equates to around 270,000 fewer patients each year. All household contacts of TB patients should be screened, in addition to PLHIV and those at high risk of developing the disease. Preventive treatment should be provided where needed.
Social protection and support mechanisms for TB patients should be augmented. Undergoing treatment for TB often involves time off work, which can impede treatment adherence. Food supplements and vouchers, transport subsidies and financial incentives are all important in ensuring the best patient outcomes are achieved and catastrophic costs are avoided. This is especially important as the region strives to achieve universal health coverage.
Finally, all national action plans should be aligned with the Political Declaration’s targets. As the region works to attain the investment target of at least $2 billion annually, all countries must stay on target. Of the 40 million people globally that require diagnosis and treatment by 2030, at least 18 million will come from South-East Asia. Of the 30 million that require preventive treatment, the region will cover at least 10.5 million.
Though the region’s work is cut out, the foundations for progress are strong. There’s commitment; technical capacity; community buy-in and partner support. In other words, the area has all the assets needed to ensure the End TB strategy’s milestones are met and the Political Declaration’s targets are reached. WHO is committed to supporting member states achieve each of these outcomes and to securing the region’s continued progress. Ending TB by 2030 is possible. We must dare to be bold.
(The writer is the Regional Director of WHO-South East Asia)