It is not natural disasters but manmade barriers that block access to TB care

Shobha Shukla, Bobby Ramakant– CNS
Contd from previous issue
What works really well in the Global North may not work well in the South. Health technologies conceived, designed, and manufactured in the Global North, and funded mostly by the Global North, are being rolled out in the Global South in a way those sitting in the North decide, said Mitra.
“I have every right to demand the best possible diagnosis and treatment. Just because someone is born in the Global North, her/ his/ their right to a healthy life is not in any way higher than mine,” added Mitra.
There are inequities and injustices within richer Nations too. But global health challenges in the Global South are so predominant and deadly that they are thwarting health security and sustainable development.
The deadly divide in 2024
WHO’s highest level initiative Find.Treat. All-backed by Stop TB Partnership and others (first launched in 2018), calls upon all countries to replace a TB test (microscopy which underperforms in diagnosing TB) 100% with WHO recommended highly accurate molecular tests by 2027. But only 47% of those with TB disease got a molecular test diagnosis in 2022 as per the WHO Global TB Report 2023. If we use a bad test that underperforms in diagnosing TB (like microscopy) we will miss TB even among those who take that test. These people who are not accurately and timely diagnosed suffer unnecessarily due to TB, as well as the infection keeps spreading from one person to another. Making upfront molecular test diagnosis is an essential cog-in-the-wheel to finding all TB - and entrygate to TB care pathway.
Addressing human-made inequities that jeopardise access to TB care services remains a critical bottleneck. We are failing to ‘reach the unreached’ – at least one-third of the estimated people with TB globally are not notified to TB programmes (we do not know how, if at all, they get a TB test or treatment or any other care or support). Walking the talk on what Mitra and Dr Ditiu have said - to end inequities in global health – is key. Let us take the best of existing TB services equitably to the communities (and closer to the people) in high TB burden settings with dignity and respect.
Linking all those diagnosed with effective and best of WHO recommended treatments is vital.
Antimicrobial resistance is among top-10 global health threats
When it comes to treatment, we have to ensure that a person is being treated with a regimen of medicines to which her/ his/ their TB bacteria is not resistant to. This is possible with a test called drug susceptibility test (DST). Those who get upfront molecular test for TB also can know if they are resistant to one (or few) of the medicines. Not doing upfront DST before initiating the treatment is clinical malpractice, had said Dr Mario Raviglione over 10 years ago to CNS. He was the Director of the WHO Global Tuberculosis Programme for almost 1.5 decades. Now, Dr Raviglione is a Professor of Global Health at the University of Milan, Italy, and founding director of the Centre for Multidisciplinary Research on Health Science. He is also an honorary Professor in Queen Mary University London.
Dr Raviglione commented on a LinkedIn post recently: “Indeed, if it [not doing upfront DST] were malpractice 10 years ago in the first years of the era of rapid molecular testing for TB and drug resistance, today it is a crime. Who would ever treat any life-threatening infectious disease without DST in 2024?"
“The acceleration of doing upfront DST we thought would happen when the new End TB strategy was endorsed by the World Health Assembly in 2014. But it did not become a reality due to many factors, including, but not limited to, COVID-19. Even before it, there was no acceleration in decline of TB incidence and death despite high-level political events. Evidently, we need much more on commitment, persistence and research investments. We are all simply not doing enough to address TB-specific challenges, broader health service and system weaknesses, and social determinants of diseases of poverty. At this pace, TB elimination will remain a dream of a few visionary people, while ‘the youth grow pale and spectre-thin and die.’ In the end it comes down to political will at the highest level. Where this will was present results were quick: think about the dozen antiretroviral medicines (ARVs) and rapid HIV diagnostics available and the COVID-19 vaccine. In TB we need exactly the same approach. Citizens are the ones that can make it happen if they just speak louder and keep acting!”, said Dr Raviglione.
Why are 1/4/6 regimens not a reality for everyone in need?
Today we have the best of treatment regimens that can treat latent TB in 1 month, drug-sensitive TB in 4 months, and drug-resistant TB in 6 months. All of these are all-oral treatment regimens, and they are also far more effective and less toxic than the earlier ones. And yet, ALL people in high TB burden nations are not able to access them.
“My dream is to have one treatment to treat all forms of TB – be it drug sensitive or drug-resistant,” says Professor (Dr) Rajendra Prasad who has served the TB response for over 50 years.
End the deadly divide between ‘what we know’ and ‘what we do’
Science has told us what works best to find all TB, treat all TB and prevent all TB. But the reality on the ground is very different at times than ‘what we know is best to do’. We need to end this gap and find all TB, treat all TB and stop the spread of infection – at the earliest.
(Shobha Shukla and Bobby Ramakant co-lead the editorial of CNS (Citizen News Service) and on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development (APCAT Media). Follow them on Twitter @shobha1shukla and @bobbyramakant)
Shared under Creative Commons (CC)