Community voices key to tackle TB
The Government has set an ambitious tuberculosis eradication goal by 2025. Collaborative efforts are a must
Recently, the Union Government launched a Tuberculosis-free India campaign under the National Strategic Plan to eliminate Tuberculosis (TB) by 2025, five years ahead of the global target. This is a welcome step and an encouraging sign for all TB control campaigners across the globe as we prepare for the United Nations high-level meeting on TB later this year. Ending TB in India is a real possibility, but will require a combined effort between Central and State Governments and communities.
TB disproportionately impacts the poorest and most marginalised sections of the society. In 2016, the disease killed 432,000 people in India, making it a world leader in TB-deaths across the world. Indians living in absolute poverty, who lack quality infrastructure, or live in remote areas, are often deprived of quality healthcare. This increases the likelihood of a person infected with TB going undiagnosed, unreported and untreated. In 2012, the International Union Against Tuberculosis and Lung Disease (The Union) initiated the Stream Clinical Trial to address the challenges posed by the increasing number of multi-drug-resistant (MDR) TB cases. Grueling two-year treatment courses leave many patients struggling to endure the complete regimen, consuming a total average of 14,000 pills.
The sheer logistics to ensure an adequate supply and efficient distribution of drugs present a high barrier to reliable treatment, sometimes resulting in serious permanent side-effects, including deafness. Many patients even struggle to complete their regimen. A lack of access to primary health care — and unregulated private healthcare — present additional hurdles for TB patients. Over the last five years, the Government of India has made significant gains against the rise of MDR-TB through several new initiatives. These include a scale-up and expansion of drug resistant TB services to achieve nation-wide coverage; revised guidelines that help tailor patients' drug regimens taking into account drug sensitivities; and the roll-out of a programme to enhance access to newer drugs. These advances established a strong footing for the rollout of Stage II of the clinical trial.
In December 2017, India screened the first patient for Stream Stage II, which seeks to garner evidence and assess the success of a shorter MDR-TB treatment regimen, including an all-oral treatment option. India is the first country from the World Health Organisation's South-East Asian region to join the trial. Progress to-date has been positive. But to ensure the Stream trial's success, vital strategies and our partners have made community engagement a cornerstone of the programme. We know, community-led interventions can help motivate public health workers, and that success stories can encourage patients and their communities to become advocates for effective TB control programmes. In India, for example, we've created Community Advisory Boards in areas that have never hosted a clinical trial of this scope before. Members play a vital role in identifying challenges, suggesting solutions, planning, and ensuring optimal research implementation.
Our Community Engagement Plan involves clinical researchers, local stakeholders (from health professionals to TB/HIV activists) and programme managers, and outlines the necessary steps needed to ensure at-risk communities are engaged. It also helps members understand the opportunities the clinical trial offers to improve quality of care.
In the search for a shorter regimen, these community voices are critical, creating an opportunity for communication and cooperation among everyone directly involved with or affected by this trial. Local communities can be actively involved in the study, and can, therefore, help maximise the benefits gained for the community while giving researchers a first-hand account, and a deeper perspective, on how local health systems function in the places we work.
Community engagement means people will have a better understanding of what we are doing, how it affects them, and why it matters in their neighborhood. It also builds sustainable partnerships, and provides legitimacy to the Stream trial's goals and objectives. After the clinical trial concludes, patients can become living proof of the benefits of this shorter regimen. If our plans are successful, we will raise the level of participation among stakeholders to identify and address issues and concerns. This level of participation is well-aligned with the Indian Government's National Strategic Plan which highlights community engagement as a crucial element to tackle TB by 2025. There are no stronger advocates for TB than those affected by TB. Government and communities must take up the charge for improved diagnosis and a more humane treatment regimen.
(The writer is President and Chief Executive Officer, Vital Strategies and Executive Director, The International Union Against Tuberculosis and Lung Disease)
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