Make a Global Priority of Finding Missing Cases of Tuberculosis

By Eliud Wandwalo, Senior Disease Coordinator, TB

in Voices on 10 October 2017

The Global Fund / Jonas Gratzer

Every year, 10.4 million people get sick with TB, an entirely preventable and curable disease. But more worrying, 40 percent of these individuals do not even receive care – they are “missed” by health systems after failing to be diagnosed, treated or reported. Essentially, they are missing because we have not done enough to remove the barriers they face to accessing the right services, or because they belong to vulnerable populations that are hard to reach, such as migrants, miners, refugees, children and people living with HIV. The missing cases could also be patients who were treated but never reported under the national programs. The result is many of these people will die or continue to be sick and transmit the disease or, if treated with improper drugs, contribute to the growing menace of drug resistance.

Missing TB cases and drug-resistant TB are major challenges in fighting the disease, and pose a serious threat to global health security. Deaths from drug-resistant TB – when tuberculosis bacteria do not respond to first-line anti-TB drugs – now account for about one-third of all antimicrobial resistance deaths worldwide. Urgent action is needed to break the transmission cycle of TB and drug-resistant TB to save millions of lives and achieve the global goal of ending TB as an epidemic by 2030. The longer the delay in finding the missed cases, the longer it will take to reach global targets.

The Global Fund partnership has launched a new investment aimed at finding missing cases of both drug susceptible TB and drug-resistant TB. The new effort invests in innovative and targeted interventions, gathering evidence and expanding the most successful approaches. Through a comprehensive package of services that will vary depending on the setting, partners hope to find an additional 1.5 million TB cases by 2019 in 13 countries that have 70 percent of all the people with TB and drug-resistant TB who are missed by current systems.

During the 48th Union World Conference on Lung Health, to be held October 11-14 in Guadalajara, Mexico, partners from WHO, Stop TB Partnership, and the Global Fund and implementers from Bangladesh, Democratic Republic of Congo, Indonesia, Myanmar, Nigeria, Pakistan, Philippines, South Africa, Tanzania, Ukraine, Kenya, Mozambique and India met to support and launch the joint effort.

The TB Catalytic Investment initiative includes US$115 million in matching funds designed to support country-led programs. An additional US$10 million Strategic Initiative will be used to help technical partners to develop a number of tools based on best practices. Finally, a US$65 million multi-country investment will address cross-border issues such as drug-resistant TB response among migrant workers, and provide treatment to refugees and internally displaced people.

What sets this investment apart from other efforts is that it adopts approaches that are not business as usual, focusing on key populations at high risk of TB who are underserved and marginalized. Interventions will contain the basic principles of searching, diagnosing and treating all forms of TB in adults and children, and preventing the development of TB, including drug-resistant TB.

Among other things, this means systematic and routine screening during health visits, as well as early diagnosis of TB and drug-resistant TB through the use of more sensitive screening, and more specific diagnostic tools such as X-rays and GeneXpert technology.

Investments will also be used to develop a closer engagement from private and public sector providers to accelerate TB case finding and treatment. In many countries in Southeast Asia, the majority of TB patients consult or access private care providers due to different reasons, so it’s very important that data is entered into the national TB systems. Innovative models of care in the private sector have demonstrated good results. In India, for instance, the result led to the notification of hundreds of thousands of missing people with TB.

Reaching missing patients also calls for expanding programs that support integrated community and family-based approaches to TB and drug-resistant TB care. In countries such as Nigeria, for instance, we need to focus investments on strengthening and better equipping primary health care to accelerate case finding.

Globally, only half of multidrug-resistant tuberculosis patients who initiate treatment are successfully treated, mostly due to high mortality and falling out of the treatment, so we need to support countries to ensure high quality of care and improve access and treatment outcomes.

To help partners better understand who and where the missing cases are located and identify the main barriers for accessing TB services, the Global Fund will support gender and legal assessments.

In our globalized world, diseases such as TB know no borders; as people move, so do diseases. Finding the missing cases and ending TB is critically important for all across the world: Not only will it save millions of lives and reinvigorate communities in vulnerable, low- and middle-income countries, but it will also have an impact in improving global health security.