3 Ways to Reach the 3 Million: World TB Day 2015

3 Ways to Reach the 3 Million: World TB Day 2015

{Photo credit: MSH staff/Afghanistan}Photo credit: MSH staff/Afghanistan

“I started feeling this coughing… so I went to the health center and got tested. It was positive for TB,” says Grace*, a young Ugandan woman. She started on medicines, but after two months, she stopped adhering to treatment.

They told me to continue with the drugs for five more months, but I stopped.

I thought I was ok.

She started coughing again, went to the hospital, and was diagnosed with multidrug-resistant TB (MDR-TB). MDR-TB cannot be treated with two of the most powerful first-line treatment anti-TB drugs. Her treatment regimen? Six months of injections and two years of drugs.

Grace’s story is all-too common.  1 in every 3 to 4 people – an estimated two billion worldwide – are infected with Mycobacterium tuberculosis, more commonly known as tuberculosis or TB. 1 in 10 will develop active TB in their lifetime. In 2013, an estimated 9.0 million people developed TB; about 3 million – 1 in 3 – did not get the care they need. TB is preventable, diagnosable, and curable. Despite major successes reducing global TB prevalence and mortality rates, TB remains one of the greatest infectious disease killers globally, only slightly behind HIV & AIDS. In 2013, about 1.5 million people died from TB; about 360,000 of those who died also had HIV.

Support Countries and Communities to Reach, Treat, Cure Everyone

The newly released World Health Organization’s (WHO) Post-2015 End TB Strategy suggests three pillars for achieving a world free of TB and ending the global TB epidemic by 2035: 1) integrated, patient-centered TB care and prevention; 2) bold policies and supportive systems; and 3) intensified research and innovation. 

Today, World TB Day, we renew our commitment to reach the 3 million: to reach, treat, and cure everyone. As Eric Goosby, newly appointment United Nations Secretary General’s Special Envoy on Tuberculosis and chair of the Global TB/HIV Working Group of the WHO, says in an interview for the WHO bulletin:

If we can get patients on treatment, we can cure them.

... I am confident that by refocusing our attention on the basics, we can strengthen service delivery in most countries. Also, by providing technical assistance to help boost the capacity of each ministry and by drawing on community-based strategies, we can save many lives.

We couldn’t agree more.

We cannot reach, treat, and cure everyone if we do not help countries and communities lead on TB care, prevention, and control.

Here are 3 ways to help countries and communities reach the 3 million:

1. Ensure access to safe and appropriate medicines

The world recently saw the approval of the first new TB medicines in 50 years. This development is both cause for excitement and a call to action. These medicines provide new hope for patients and the global community, but only if they are carefully monitored for safety and regulated to ensure appropriate use. Through the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, MSH is working with partners to ensure both of these goals are met.

SIAPS is partnering with national TB programs (NTPs) to promote patient safety through strong pharmacovigilance systems, which help detect, assess, and treat side effects patients experience while on treatment. Appropriately managing adverse drug events helps ensure patients stay healthy and are able to complete the full treatment course, a grueling regimen that can last up to two years. SIAPS is also supporting NTPs to successfully manage TB medicines using tools like QuanTB as part of an early warning system. Combined with training in forecasting and quantification, early warning systems help countries avoid medicines stock-outs and waste. Safeguarding continuous patient access to quality medicines is a key requirement for achieving cure and preventing the development of drug resistance.

Today and every day, MSH/SIAPS is working with NTPs and partners around the world towards the WHO vision of, “A world free of TB”.

2. Expand model programs for integrated, patient-centered approach to TB in communities, Urban DOTS in cities

Since its launch in July 2011, USAID’s Help Ethiopia Address Low TB Performance (HEAL TB) project, led by MSH with partners, has improved TB case notification, treatment, and cure rates, improved HIV testing of TB patients, and strengthened management of MDR-TB throughout Ethiopia's Amhara and Oromia Regions. In three years, the project-supported facilities diagnosed more than 130,000 cases of TB (all forms) and initiated these patients on treatment. In 2014, HEAL TB’s success inspired USAID to expand the project’s coverage from 10 zones to 21 zones; and, recently, to add 7 more zones, supporting 28 zones within the two regions. Now, HEAL TB interventions support more than 54 million people—over half of the country’s population.

In cities, such as Kampala, Uganda, and Kabul, Afghanistan, strengthening health facility teams in Urban DOTS (directly observed treatment, short-course strategy), and improving coordination with TB/HIV service provisions and community based MDR-TB interventions, is bettering treatment success rates. Now, we are working with partners, including through USAID's Challenge TB: A New Worldwide Tuberculosis Project led by the KNCV Tuberculosis Foundation, USAID's TRACK TB (Uganda), and HEAL TB (Ethiopia), to expand implementation and coordination of Urban DOTS in other cities.

3. Advocate and innovate for funding, research and development

If we are to continue the progress since 1990, global donors, countries, and public and private sector partners will need to increase funding and resources for implementation, innovation, and research and development on TB. Governments of high burden countries must be convinced to invest more domestic resources in TB care and treatment services to prevent further transmission, as well as save lives and money. Global donors and partners must continue to fund and support efforts to not only implement, but also to innovate, research, and improve health systems approaches to TB, including pediatric TB.

Supporting countries and communities, we can – and must – reach, treat, and cure everyone with TB.

Join us today in our efforts to reach, treat, and cure everyone. Here are some things you can do:

Reach, Treat, Cure Everyone: What you can do

  • Grace, the woman I told you about at the beginning (name changed to protect privacy), has been adhering to her MDR-TB treatment, and now advises friends:

    Go and test for TB!

    Read more about her and our work to support better MDR-TB detection in Uganda through TRACK TB.

  • Did you know? TB most especially affects people who are poor and experiencing crowded living or working conditions, poor ventilation, lack of access to clean water and sanitation, prisoners, miners, and those whose health status is already compromised, as well as women, children and people living with HIV. In fact, TB is the leading cause of death in people living with HIV. We’re working with Discovery Learning Alliance, makers of Inside Story (a feature film about HIV), to develop a feature film about TB, with information about how to avoid infection and remain healthy.  Stay tuned on Facebook for more about the film.

  • Learn more: About one third of new TB cases occurred among women, and about 510,000 women died from TB in 2013. Over 500,000 children under the age of 15 were estimated to have fallen ill, and over 70,000 children died in 2013. Read the WHO Global TB Report 2014 and new WHO post-2015 end-TB strategy for more.

  • Share this message, infographics from Stop TB Partnership, WHO, USAID, and SIAPS, and other TB-related news with your friends and family. On social media, use hashtags , , and .

  • Are you or someone you know infected with TB, MDR-TB, or TB and HIV? Get tested. Stay on treatment. Support your community response to TB. For further resources, visit Stop TB Partnership.

Several MSH staff contributed to this content.