Urgent need to invest in resources to combat TB

World Tuberculosis (TB) Day is on 24 March. It is an annual event to raise awareness about the health, social and economic consequences of TB.

The date commemorates Dr Robert Koch’s isolation of the bacterium that causes TB in 1882, which paved the way towards diagnosing and curing the disease. TB is one of the most infectious and deadly diseases globally. In 2020 alone, 9.9 million people were diagnosed with TB, and 1.5 million deaths were recorded.

The good news is that since 2000, global efforts to end TB have saved an estimated 66 million lives. Unfortunately, the Covid pandemic hindered this progress, however, and 2020 saw an increase in cases for the first time in over a decade.

“Invest to End TB. Save Lives” is the theme for World TB Day this year and it highlights the urgency for investment in the resources required to fight TB and the commitment needed from global leaders to end TB altogether.

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The pandemic halted the progress of the End TB campaign and leaders need to do their part in ensuring equitable access, not only to prevention but to adequate diagnostics and care. The more investment there is, the more lives will be saved.

One, Tuberculosis is caused by Mycobacterium tuberculosis, a bacteria, and has its most profound effect on the lungs. Because it is airborne, it is highly infectious and spreads when people cough, sneeze or spit. To become infected, all someone must do is breathe in infected air particles.

TB is preventable and curable, yet 10 million people fall ill with tuberculosis annually. It remains the world’s most infectious killer and is also the leading cause of death for those infected with HIV. Low- to middle-income countries account for 98% of TB infections. Although it is estimated that 25% of the world’s population is infected with TB at any given time, only 5 to 15% will fall ill.

However, an asymptomatic person is as infectious as one with symptoms. TB has been prevalent for many years, and many of the antibiotics available are no longer working. The various strains have become drug resistant. Multidrug-resistant tuberculosis does not respond to isoniazid and rifampicin, the first-line anti-TB medication. There are limited second-line treatment drugs, but they also require extensive chemotherapy.

The most common symptoms of TB include a persistent cough that can bring up mucus and blood. Other symptoms include fatigue, night sweats, fever, loss of appetite and weight loss. Symptoms can remain mild for several months, which often delays treatment.

A rapid molecular diagnostic test should be done if these symptoms present, as they are highly accurate and lead to quick treatment. Drug-susceptible TB can be treated with a course of antimicrobial drugs. TB is the leading cause of death from a single infectious agent.

Twenty-five percent of all TB cases are in Africa and so are 25% of all deaths. Africa’s HIV burden causes further complications, as those infected with HIV are 18 times more likely to develop TB. The conditions form a lethal paradox, both accelerating the development of the other. Eightyfive percent of TB patients in Africa are also HIV-positive.

The World Health Organisation (WHO) global tuberculosis programme aims to lead and guide the global effort to end the TB epidemic once and for all. Ending TB is a developmental challenge, as well as a public health issue.

WHO adopted the End TB strategy in 2014, highlighting that the way forward requires universal access to patient-centred prevention and care, multisectoral action and innovation. The strategy serves as a road map to eliminate the catastrophic costs for TB-affected households by 2030.

The goal is to reduce TB incidence by 80% and TB deaths by 90%. The strategy is tailored to each country’s diverse needs and contributing factors. Ultimately, all people should have access to high-quality diagnostics through meaningful partnerships – both public and private.

Reliable and accurate diagnosis reduces the risk of further transmission, delays in treatment and additional burdens on the healthcare system.”

• Keytel is head of healthcare transformation and sustainability at Roche Diagnostics