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Tuberculosis
MalariaPeople with TB are often stigmatized. In some cultures, it is because TB is associated with witchcraft or with being cursed. Frequently, it is because those living with TB are also living in poverty, dependent on drugs or alcohol, or socially isolated for other reasons. Fear of being stigmatized may mean that people delay seeking help until seriously ill. Not only do they risk infecting those around them, but treatment is much less effective if it is left until the disease is in its advanced stages.
Tuberculosis is one of the world’s most deadly infectious diseases. In 2015, TB killed 1.8 million people, including 400,000 people with HIV, making it one of the top ten causes of death worldwide.
TB has been around for millennia – traces of TB have even been found in Egyptian mummies. Once known as consumption, the disease is closely associated with poverty. TB is spread from person to person through coughing and sneezing, making overcrowded and poor living conditions the perfect medium for the spread of the disease.
There are an estimated 10.4 million new cases of TB every year, or approximately 28,000 new cases every day. Roughly 40 percent of those cases are missed – not diagnosed or not treated or not reported. Those who are most vulnerable to TB include women and children, the very poor or malnourished, people who use tobacco products, prisoners, miners, indigenous populations, the elderly, and people living with HIV.
Public private partnership is key
Myanmar is one of the world’s 30 high-burden countries for TB. Because many people in Myanmar choose private health care rather than government facilities, the government implemented a program with Global Fund support to train private health care providers in TB prevention, diagnosis and treatment. Dr Yu Yu May, who is a franchisee of Sun Clinics (a private health care network), provides health care out of a clinic in her home, providing free TB testing and treatment to her community. She also works with several volunteers, who carry out TB awareness programs in local communities.
Because it affects mostly young adults in their most productive years, TB is a huge burden to development. The disease, which is both curable and preventable, is caused by bacteria and is spread from person to person through the air by coughing and sneezing. One person with active, untreated TB can spread the disease up to 15 other people in a year.
Treatment for TB can be arduous – a strict course of daily antibiotics for a minimum of six months. Although treatment is free of charge in many countries, following a treatment plan that requires that patients be observed taking their medication each day to ensure adherence can be burdensome, particularly for those struggling to make a living.
Drug-resistant tuberculosis
Without community support, TB patients frequently stop the treatment before it is completed, allowing the bacteria to mutate. The bacillus then becomes resistant to the anti-tuberculosis drug. This is what we refer to as drug-resistant TB. There is also the risk that they will spread the drug-resistant form of the disease to others. Today, there are approximately 480,000 cases of drug-resistant TB each year.
Drug-resistant TB is much more difficult to treat, requiring up to two years of medication and often requiring hospitalization for the first months of treatment. And the cost of treatment can be as much as two hundred times the cost of treatment for standard TB, a significant burden on any country’s health infrastructure. Extensively drug-resistant TB – an even more severe form of drug-resistant TB – responds to even fewer available medicines.
Diagnosis is also a challenge with drug-resistant forms of the disease. Until recently, it could take weeks to confirm a diagnosis of the particular form of TB involved. With the recent introduction of GeneXpert machines, that time has been reduced to hours.
Tuberculosis and HIV
Up to one third of the world’s population has latent TB, but only about 5 to 10 percent develop symptoms of active TB. Individuals with compromised immune systems – such as people living with malnutrition, diabetes, HIV, or who use tobacco – have a higher risk of developing active TB.
HIV and TB are a deadly combination, as each fuels the progress of the other in infected patients. TB is the leading killer of people living with HIV; about one in four deaths among people with HIV are due to TB. Those who are HIV-positive are up to 30 times more likely to develop active TB than those who are not. Which is why it is vitally important, particularly in countries with a high burden of TB, that services for HIV and for TB be integrated. Every person who is HIV-positive should be screened and monitored for TB, and every person diagnosed with TB also needs to be tested for HIV.
Progress in the response to tuberculosis
Progress is being made. The mortality rate for TB fell by 47 percent between 1990 and 2015, and it is estimated that effective diagnosis and treatment have saved some 49 million lives between 2000 and 2015.
The development of new diagnostic tools such as the GeneXpert machine has greatly aided the response to multidrug-resistant TB. New drugs are also being introduced, particularly for MDR-TB, which have the potential to reduce the burden on both national health budgets and the patients.
In 2016, WHO introduced a new treatment regimen for MDR-TB which reduces the course of treatment from two years to less than 12 months.
Ambiya's Story: A teenager cured of drug-resistant TB
Meet Ambiya, a 15-year-old girl in Jakarta, Indonesia being treated for drug-resistant tuberculosis, through support from the Global Fund. Having drug-resistant tuberculosis means that regular TB treatment isn't effective. The 18 month treatment which has cured her of this deadly disease became available through the public health system in Indonesia starting in 2009.
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Published 20 July 2017