World TB Day: Tracking a Contagion

Reuben Kimweli walks briskly, squeezing through a low and narrow alleyway between mud shacks in Kibera, Kenya’s biggest slum. He calls greetings to men playing a game of cards, then turns a tight corner, careful not to step on a chicken. To get to the home on his mind, he negotiates more stretches like these, jumps trenches and, yes, asks directions.

With no listed physical addresses, those who give directions here count on neighborhood landmarks: next to the shop by the gulley, after the tree with giant branches, then walk straight past the huge street light. His sleuthing may mimic a police detective, but he is a different type of an investigator. All the same, he is pursuing a potential killer.

Reuben is one among thousands of community health workers on the frontlines of the global effort to track down more than 4 million cases of tuberculosis that go undiagnosed, untreated or unreported every year. According to the Global Tuberculosis Report 2016, 40 percent of the 10.4 million people who get sick with TB, and 80 percent of the 580,000 people suffering from drug-resistant TB, are missed by health systems every year. And you can’t stop a disease if you can’t find it.

Despite advances in diagnostic tools and newly updated treatment regimens, the world has been unable to stay ahead of the disease. Lucica Ditiu, Executive Director of the Stop TB Partnership, says that if the world stays the current course – cutting incidence rates by 1.5 percent a year – it will take 170 years to eliminate the disease. That takes us to the year 2187.

The good news is, TB is preventable and curable. The bad news is, it is contagious and transmitted through the air; a person with active TB but who goes without treatment can infect an additional 10-15 people a year. So long as millions of people live with the disease without treatment and continue to transmit the infection to others, we will not bend the curve of TB incidence downwards, and TB – particularly multidrug-resistant TB – will remain a growing threat to global health security.

When Reuben met Agnes, she had already been diagnosed with TB and was on treatment. But as a school teacher, Agnes’ profession meant she posed a high risk to others. Reuben walked the treatment journey with her, advising her to postpone her classes until she was declared non-contagious. He also monitored the health of the children she had taught, ready with a quick referral if any became sick. Fortunately, none did.

Agnes’ own children were not as lucky; three of her four sons contracted TB. But Reuben’s quick assessment and intervention meant speedy diagnosis and treatment – the whole family is now TB-free.

“I love what I do. I grew up in Kibera. I know where to go to reach people affected by TB – to trace contacts who might also be infected and to engage with people who have stopped their treatment,” says Reuben, who works for a program run by Amref Health Africa with support from the Global Fund.

Catalytic funding

In 2015, tuberculosis traded places with HIV to become the deadliest infectious disease in the world, killing an estimated 1.8 million people. The rising magnitude of the disease is compounded by the growing threat of drug-resistant TB, and with the millions of people missing from treatment. To end TB, the world will need all partners to work together, faster on this issue.

With a new investment called catalytic funding, the Global Fund is supporting innovative programs, gathering evidence and expanding the most successful approaches to find cases of TB missed by the public health systems. Among other things, this means adding TB screening to other routine check-ups during medical visits, and developing more efficient and effective ways for private health care providers who are treating TB cases to report those cases to the national TB program. 

The Global Fund is investing an additional US$115 million in 12 countries that account for 55 percent of all missed cases of TB and multidrug-resistant TB: Bangladesh, Democratic Republic of Congo, Indonesia, Myanmar, Nigeria, Pakistan, Philippines, South Africa, Tanzania, Ukraine, Kenya and Mozambique.

To end TB as an epidemic by 2030, global health partners need to get 90 percent of all people with TB on treatment. To hit those numbers will mean braving a steep climb – currently, reported rates of treatment only reach 59 percent of people with TB and 21 percent of people with drug-resistant TB. Governments, private sector, nongovernmental organizations and communities affected by the disease must find ways to take treatment, care and support to all the people affected by TB – until none is “missing.”