Q&A: Lucica Ditiu and Mohammed Yassin on Millions of Missing TB Patients

21 March 2017 by Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership, and Dr. Mohammed Yassin, Senior Disease Advisor for TB at the Global Fund

For World TB Day 2017, we asked Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership, and Dr. Mohammed Yassin, Senior Disease Advisor for TB at the Global Fund, questions about current efforts to combat TB and the crisis of millions of missing cases worldwide.

Q: What is the state of tuberculosis in the world today?

LD: First, thanks to better data, we now know that the burden of TB is much greater than previously estimated. TB now kills more people than any other infectious disease. Second, TB is declining at a very slow pace – the current progress is completely off-track to meet the Sustainable Development Goal of ending TB as an epidemic by 2030. Third, we are stuck in a situation where millions of people who are sick with TB are not getting the proper care – the missing cases. We must get better at rolling out new diagnostic technologies and drugs, modernizing data and record keeping, and engaging communities to reduce stigma and support TB patients throughout their treatment.

Q: What does “missing cases” mean – if we know they are out there, how and why are they missing? 

LD: Missing means the gap between the number of people that WHO estimates get sick with TB every year and the number of people that are reported to national TB programs, and in turn to WHO, every year. Fundamentally, they are missing because we have not done enough to remove the barriers they face to accessing the right services. The result is many of these people will die or continue to be sick and transmit the disease or, if treated with improper drugs, develop drug resistance.

Q: Why has the Global Fund prioritized “missing” TB patients; how does Catalytic Funding bolster existing efforts?

MY: Missing TB cases and drug-resistant TB are major challenges in fighting the disease. Our goal is to stop transmission and reduce illness and death due to TB, so there is urgent need to reach this group of patients and provide them treatment. Expanding existing interventions and tools is important, but not adequate to accelerate the reduction in TB burden globally. There is a need for a paradigm shift. Catalytic funding for TB is aimed at supporting innovative programs to find missing cases of the disease, gather evidence and scale up the most successful approaches.  

Q: Aside from financial support, are there other ways the Global Fund supports countries to find and treat TB patients?

MY: Global Fund grants can be used to leverage additional resources from domestic and other sources to reach the missing cases. In addition to financial support, we need political commitment, community awareness, innovation and participation from private-sector providers to accelerate TB case finding and treatment.

Q: Has the effort to find missing cases stagnated?

MY: We have to acknowledge that current case finding efforts are inadequate. There has been little or no increase in the number of TB cases identified, which simply does not align with the estimated number of new TB cases, including drug-resistant cases. Therefore, the number of missing cases has actually increased to 4 million in 2015 – 40 percent of estimated new TB cases globally.

We know, for example, many patients access services outside national TB programs. So it is critical that all care providers are engaged and equipped with the tools and information they need to provide quality TB services, and notify national programs about these patients with an aim of reducing the pool of missing cases. There has been some progress in engaging private sector providers, but we can do more. 

Q: What can be done to accelerate impact?

LD: As Mohammed mentioned, the Global Plan to End TB 2016-2020 calls for a “paradigm shift” in the approach to be on course to end TB by 2030 – this means a massive and well-coordinated effort to scale up care, deploy new tools and drugs, and intensify interventions to reach those left out by current approaches.

There is good news: We are beginning to see some early initiatives by countries to change things. More heads of state in high burden countries are joining and leading the fight against TB. The UN General Assembly high-level meeting on TB – the first meeting of that magnitude on the fight against the disease – is a crucial opportunity for engaging these leaders and securing high-level commitment.