TB REACH and the Global Fund: A Partnership to Find and Treat the “Missing Cases”

02 June 2017 by Eliud Wandwalo, The Global Fund & Jacob Creswell, Stop TB Partnership’s TB REACH Initiative

In 2015, the tuberculosis death toll rose to an estimated 1.8 million worldwide, while 10.4 million people fell ill with the disease. TB is now the leading cause of death from an infectious disease – a truly unacceptable situation when the disease can be effectively treated and cured. While some global TB indicators, like treatment success, have improved and mortality rates have fallen, there is a large and persistent number of people each year who fail to be diagnosed or treated at all.  

These “missing” people with TB usually include the most vulnerable and those without proper access to care. They include people living in poverty, in remote communities, people living with HIV, miners and migrant communities. Many tools and guidelines have been developed in recent years that have led to more accurate and faster diagnosis, and the Global Fund has supported countries to roll out and expand access to the latest TB diagnostic technologies. However, the TB epidemic can only be successfully curbed if we are able to find the missing 4.3 million people who are estimated to suffer from TB and multidrug-resistant TB – and who go without treatment. More and new partnerships need to be forged within the global TB community and beyond to implement innovative and comprehensive approaches to find the missing people with TB.

For the 2017-2019 allocation period, the Global Fund is making new, catalytic investments to bolster country allocations for improved delivery of results and impact on the ground. Catalytic investments include matching funds of which US$115 million allocated to 12 priority countries to support interventions that can successfully find the missing TB cases.

In light of the ambitious goal to detect, notify and treat 1 million additional people with TB by 2020 compared to 2015, the collaboration between Stop TB Partnership’s TB REACH initiative and the Global Fund is being intensified. Under a new Memorandum of Understanding, the two organizations will work to improve the quality and impact of Global Fund investments focused on TB case finding, detection and treatment. Special focus will be placed on the 12 priority countries for matching funding for TB, and 14 additional impact countries, which together represent 83 percent of all missing TB cases globally.

This is another important step toward more effectively addressing the TB epidemic, both nationally and globally. The Global Fund strongly encourages countries to be ambitious in implementing more cutting-edge approaches for TB health service delivery that are inclusive of high-risk groups and vulnerable populations – an excellent fit with the work TB REACH has been doing for the last five years. To date, TB REACH has supported 144 projects in 46 countries that have screened more than 33 million people, detected over 1.9 million TB cases and linked patients to proper care.

In 2013, TB REACH funded a social enterprise model in Bangladesh to sell high-quality, low-cost digital chest X-rays and use the revenues to support a private sector TB outreach and screening program. By 2016, just three facilities supported by the project were detecting 40 percent of all notified TB cases in Dhaka and the project has been able to almost fully cover operational costs using the revenue it generates.

In 2017, TB REACH, the Global Fund and USAID/Challenge TB will provide new grants to expand this work. Two additional TB screening centers will be established in Dhaka and four more in Bangladesh’s second and third largest cities, Chittagong and Sylhet. The program’s vast network of private practitioners for referral of TB cases will be expanded, and links with treatment facilities will be strengthened, along with other interventions such as contact tracing among family members of confirmed cases.  

Through 2020, TB REACH will launch additional rounds of funding, thanks to the new five-year contribution agreement worth CAD$85 million from the government of Canada, US$7 million in support from the Bill & Melinda Gates Foundation and US$1.5 million from the Indonesia Health Fund. These resources will create more opportunities for partners to test new approaches for improved TB health service delivery. Where feasible, innovative local and regional practices that demonstrate evidence of impact will be brought to scale – helping to ensure no cases of this curable disease go missing.