tuberculosis

A Conversation with Dr. Lal Sadasivan of PATH and Dr. Pedro Suarez of MSH

Last year, Tuberculosis claimed the lives of 1.6 million people, and it affects the lives and livelihoods of millions more. While early diagnosis and treatment can cure and prevent the spread of TB, underreporting and under-diagnosis remains a big issue. The 2018 Global TB Report found that of the 10 million who fell ill with TB in 2017, only 6.4 million were officially recorded by national reporting systems. More dangerous yet, growing drug resistance to first-line TB drugs threatens to undermine decades of progress and make treatment both more costly and complex. Still, TB can be eradicated if governments, donors and private sector actors work together to fund and execute an accelerated response to end the TB epidemic.  

This story was originally published by The Hill. 

During the 22nd International AIDS Conference in Amsterdam, scientists, policymakers, healthcare workers, advocates, and civil society shed light on the relationship between HIV and other urgent health crises, such as Tuberculosis (TB).

A less known, but critically important fact: TB is one of the leading causes of death among people with HIV/AIDS worldwide. To effectively address HIV, budget and policy responses must reflect the challenge of HIV-TB co-infection.

In June, as the House and Senate Appropriations Committees considered their fiscal 2019 foreign assistance funding bills, there was encouraging discussion about the importance of fully funding the International Affairs Budget to maintain American leadership through diplomacy and global development.

We have had this role since the establishment of the Marshall Plan after World War II, and for many good reasons. American investments in global development have proved to be beneficial to us as well.

One Project in Ethiopia Shows Us That Investing in Health Systems Pays Dividends 

Over the past five years, the Ethiopian government and MSH have been working shoulder to shoulder to improve and expand the country’s tuberculosis services with the goal of alleviating the burden of the disease.

If you wonder whether foreign assistance is money well spent, just look at the remarkable progress we’ve made in Ethiopia, where only a few years ago the stock out rate for TB drugs was as high as 20 percent. That number today is about two percent.

Our tuberculosis work in Ethiopia supported 55 million people between 2010 and 2016. During that period, we improved case detection, diagnosis, and treatment mechanisms; strengthened the laboratory capacity of more than 2,000 facilities to diagnose TB; improved the supply management of TB drugs; and trained tens of thousands of health workers at all levels of the health system.

The upside is not just the thousands of lives saved or improved, but the strengthening of a health system that is now better equipped not only to respond to TB, but also to other diseases, therefore helping the people of Ethiopia live healthier lives, contribute to their economy, and make their country a more stable and peaceful place to live.

MSH will host and support events in five countries this week to honor World TB Day.

Observed March 24, World TB Day raises awareness and mobilizes support for efforts around the world working to end tuberculosis (TB). The World Health Organization (WHO) has designated this year’s theme as “Unite to End TB: Leave No One Behind,” and many of the day’s activities will focus on addressing stigma, discrimination, and marginalization.

MSH has been a leader in strengthening health systems to fight against TB since 1999 and is working with partners in 22 countries to prevent the spread of the disease and improve the lives of those affected by it.

In Afghanistan, the Challenge TB project — funded by USAID  — will lead 20 awareness events in five cities and will deliver messaging about TB in schools and health facilities. The project will also lead conferences in three provinces, focusing on successful interventions like Urban Directly Observed Treatment and the TB Information System.

The Challenge TB project will also lead World TB Day activities in 11 districts in Bangladesh, ranging from orientations and discussions with workers, to programs at schools, to rallies, to a “sputum collection camp” at an outreach center.

This article was originally published on LillyPad, a blog run by the global health care company Eli Lilly, on February 16.

Antimicrobial resistance (AMR) is a global health crisis. In his AMR review, renowned economist Jim O’Neill estimates a loss of US$100 trillion in global productivity by the year 2050 if swift, comprehensive action to fight AMR is not taken. The publication acknowledges multi-drug resistant tuberculosis (MDR-TB) as a “cornerstone of the global AMR challenge.”

This article was originally published on Devex on October 26, 2016

I was exposed to the plight of children with tuberculosis early in my 32 years of experience as a physician. I was a medical intern in a provincial hospital in Peru's jungle region. I noticed Adrian, a severely malnourished 3-year-old child in the corner of the ward, feverish and breathing with great difficulty. His condition didn't respond to pneumonia treatment, and a chest X-ray revealed liquid surrounding the right lung. My attending physician concluded that Adrian had severe malnutrition and pneumonia and decided to continue his antibiotic treatment.

Adrian died on the third day of my watch. An autopsy revealed the little boy had been afflicted with TB. That was likely why he died, not malnutrition or pneumonia. We later found out that Adrian was living with an uncle who had recently died "coughing blood." My attending physician confessed that he had been so focused on managing the presumed pneumonia that he didn't think about TB as an alternative diagnosis.

Tuberculosis (TB) claims a life every 15 seconds; it is the single largest infectious killer and is universally recognized as a global epidemic. Nearly 200 children die every day of TB.

The challenges of tackling TB are well known, particularly in settings with limited resources, crowded urban environments, and among high risk groups including people living with HIV, prisoners, and children. The emergence of multidrug resistant strains of the disease (MDR-TB), the result of incomplete or poor managed TB treatment, present further obstacles and add exponential costs to already burdened health systems. Furthermore, challenges with access to, affordability, and proper use of pharmaceuticals and laboratory materials can have devastating consequences on diagnosis and treatment.

The key to ending TB is to work together to strengthen health systems in high TB-burden countries to be able to effectively implement both proven and innovative strategies. Four approaches will help save lives by uniting stakeholders to collaborate, innovate, and end TB:

When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days.

I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back… only then did they know it was tuberculosis.

~ Atsede Tefera

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population. Children are amongst the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted, and untreated. Today, more than 53 million children worldwide are infected with TB and over 400 die each day from this preventable and curable disease. 

Management Sciences for Health (MSH) presented seven abstracts at the 8th International Aids Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) in Vancouver, Canada, July 19-22, 2015.

Health workers throughout the developing world provide vital services and improve the lives of the people they serve, and yet they are often invisible. These men and women conduct community outreach, provide key prevention messages in the community, and deliver clinical care, treatment, and follow-up. In Uganda, the US Agency for International Development (USAID) TRACK TB project, led by Management Sciences for Health (MSH), supports 52 community linkage facilitators to help increase tuberculosis (TB) case detection and treatment success rates.

As their name suggests, they serve as the link between the patient and the health facility. The facilitators receive a monthly allowance, mobile phones, paid airtime, and transportation reimbursement as they track treatment adherence of TB patients in and around Kampala, Uganda’s capital. The facilitators are critical to successful implementation of the World Health Organization’s DOTS (directly observed treatment short-course) strategy, which helps patients adhere to treatment.