Brienne Prusak (she/her) – MSF Medical & Global Health Press Officer
As the COVID-19 pandemic threatens to derail the global response to tuberculosis (TB), the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) called today on governments to accelerate testing, treatment, and prevention of TB. It’s also critical that donors continue to provide the financial support needed to ensure increased access to new medical tools for diagnosing and treating millions of people worldwide with this disease, said MSF.
An MSF and Stop TB Partnership report released yesterday, Step Up for TB, surveys 37 high TB-burden countries and shows that critical medical innovations are reaching far fewer people than who urgently need them. This is because many countries continue to lag behind in getting their national policies in line with new World Health Organization (WHO) TB guidelines to use safer and more effective drugs and tests—sometimes because these products aren’t registered in all countries or are priced out of reach.
“Instead of stepping up for TB, we are at risk of slipping back due to COVID-19,” said Sharonann Lynch, senior TB policy advisor for MSF’s Access Campaign. “We cannot stress enough how urgent it is now for governments and donors to intensify their efforts so that critical medical innovations and tools reach people with TB. We finally have better drugs and tests to tackle and prevent this extremely infectious yet curable disease, so it’s both mind-boggling and unacceptable that they’re still not being used to save as many lives as possible.”
While reporting on the severe impact of the COVID-19 pandemic on TB services, WHO revealed a sharp drop in the number of people diagnosed. Besides needing to catch up to maintain continuity of existing TB services, it advised countries to adopt and roll out better testing policies and practices.
Presently, countries continue to fall short on rolling out up-to-date testing policies that can assist in reaching nearly the three million people still being missed each year. For example, as highlighted in the MSF and Stop TB Partnership report, a whopping 85 percent of countries surveyed still do not use the lifesaving point-of-care urinary TB-LAM test for routine diagnosis of TB in people living with HIV, which is recommended by WHO. TB disproportionately affects people living with HIV as they have compromised immune systems.
“As clinicians working on the front lines of the raging TB epidemic, it is distressing to see the sluggish uptake of TB-LAM in national treatment programs, despite its proven role in saving the lives of people living with HIV,” said Dr. Patrick Mangochi, deputy medical coordinator for MSF in Malawi. “Countries must step up the use of TB-LAM as a core component of testing services, otherwise delays in diagnosing people with TB and getting them started on treatment will continue to fail people with HIV who get TB.”
TB remains the world’s top infectious disease killer, with more than 10 million people falling ill and 1.4 million people dying from it in 2019. Implementing WHO guidelines is urgently needed to minimize the unnecessary risk of COVID-19 by reducing visits to health facilities, without disrupting treatment.
To prevent this from happening, countries must take immediate action to implement people-centered TB policies, including treatment initiation and follow-up at primary healthcare facilities rather than only specialized facilities that may be further from home. Also, national treatment programs must prioritize the use of all-oral treatment regimens for people with drug-resistant TB (DR-TB) that no longer include older, toxic drugs that have to be injected and cause serious side effects. The report finds that only 22 percent of countries surveyed allow TB treatment to be started and followed up at a primary healthcare facility, instead of travelling to a hospital, for instance, and for medicines to be taken at home. Additionally, 39 percent do not use a modified all-oral shorter treatment regimen and 28 percent of countries surveyed still are using injectable medicines when treating children with DR-TB.
“I have been through an agonizing journey of being treated with medicines with excruciating side effects, and I lost one of my lungs,” said Meera Yadav, a survivor of extensively drug-resistant TB (XDR-TB) in Mumbai, India. “Finally, in 2016, I was able to access newer TB drugs as part of the regimen that saved my life. I don’t want anyone else to have to go through this ordeal. With newer medicines, it is now possible to give people all-oral treatment that works to cure them. People with TB can’t be excluded from accessing these innovations anymore, especially when they are afraid to visit treatment centers due to COVID-19.”