‘Urgent investment required’ to get TB efforts back on track, group says
Globally, millions of people affected by tuberculosis are being diagnosed and treated with outdated tools, according to a new report from the Stop TB Partnership.
The group found that TB-related targets established in 2018 during a high-level meeting of the United Nations General Assembly are not on track to be met by 2022, and that COVID-19 has rolled back efforts in some cases.
“Earlier this year, the COVID-19 pandemic hit the world with devastating impact, and governments around the world quickly adopted new policies and laws in response. Meanwhile, TB remains the top infectious disease killer, even though it is preventable and curable,” Lucica Ditiu, MD, executive director of the Stop TB Partnership, said in a press release. “To make matters worse, most countries still use outdated policies, practices, tools and treatment regimens.”
The Stop TB Partnership released the Step Up for TB 2020 report to provide an update on the efforts of national TB policies to align with the latest international recommendations. It was discussed during a press conference Monday. The report revealed both progress and shortcomings in those efforts, including “significant policy gaps [that] risk undermining progress in the fight against TB,” the group said.
In 2019, more than 10 million people contracted TB and more than 1.4 million people died from it.
“We all must ensure that every single person affected by TB is diagnosed and treated using the latest available international guidelines and tools,” Ditiu said.
Outdated diagnostics, treatment
The report showed that many surveyed countries still have outdated testing policies that may lead to inadequate TB prevention and care, and that around 347,000 people who develop TB each year in 37 surveyed countries have a form of TB resistant to existing treatments.
“It is the right of individuals to have access to the latest diagnostics and treatment to be cured from TB because we can cure TB and we can cure drug-resistant TB if we have the right tools,” Cheri Vincent, chief of the infectious diseases division at the U.S. Agency for International Development, said during the press conference. “One of the biggest issues in TB has been the development and the deployment of those tools. And we need to do better.”
According to the report, only 1% of patients with drug-resistant TB have access to comprehensive, universal drug sensitivity tests because only six of the surveyed countries 18% have introduced necessary policies to improve access.
TB is the most common cause of death among people with HIV, and more than 28 million people with HIV reside in the 37 surveyed countries. Despite this, only 14% of surveyed countries have policies in place that allow for the use of a lateral flow urine lipoarabinomannan assay testing for TB, which has been internationally recommended since 2015. This leaves more than 17 million patients with HIV lacking access to a rapid, affordable and lifesaving TB diagnostic tool, the group said.
Some countries made progress regarding certain key indicators since 2017, when the last report was published. According to the new report, around 80% of surveyed countries — totaling more than 1.5 billion people — indicated that they are now able to use rapid molecular TB tests as the initial test for people with symptoms of TB, moving away from microscopy.
“Countries are making progress in some areas, such as the use of rapid molecular tests for TB,” Mark Edington, head of the Global TB Fund’s grant management division, said during the briefing. “That's really encouraging.”
However, Edington said about 39% of countries are likely to continue to use injectable regimens to treat drug-resistant TB (DR-TB), despite WHO recommendations from 2 years ago that prioritized oral drugs.
The Stop TB Partnership report showed that progress has been made to reduce the use of these regimens among children, however, with 72% of countries introducing injectable-free treatment regimens, benefitting 5,000 children in 2019. The survey also found that an estimated 30,000 children become ill with DR-TB every year, but in 2019, only 5,586 were diagnosed, treated and their cases reported to WHO.
To help countries, shift to new regimens, the Global TB Fund contributed $35 million immediately after the WHO recommendations were publicized, Edington said.
“I want to remind people that TB affects the poorest of the poor, so it is really a human rights issue,” Vincent said. “That is where you see the diversion from COVID-19, where the majority of those cases are not happening in these countries around the world. It is very critical that we keep our eye on dealing with TB, making sure that people that need it have the best and most important diagnostics and treatment available.”
‘Urgent’ action needed
Policies are in place to help prioritize prevention in the fight against TB. For example, each of the surveyed countries include systematic screening for active TB, testing for latent TB infection among household contacts and provision of TB preventive treatment in their national policies. According to the report, 81% of the surveyed countries with a total population of more than 2.8 billion people have additional policies in place that provide for a shorter TB preventive therapy regimen.
However, the report noted concern over a finding that nearly half of countries did not have policies on the provision of TB preventive treatment to household contacts, despite committing to a specific U.N. target on this to be achieved by 2022.
Additionally, most of the surveyed countries did not require the approval of a stringent regulatory authority or WHO prequalification for imported or locally manufactured TB medicines, putting people living with TB at risk for being treated with substandard medicines that could worsen or make the illness harder to treat.
According to the report, “urgent investment is required” to get global efforts back on track to meet 2022 targets.
“WHO has been rapidly reviewing new evidence and updating policies and guidelines to ensure that people with TB access quality prevention and care as soon as possible. This includes guidance during the COVID-19 pandemic promoting home-based care and digital innovations,” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, said in the release. “We urge all countries to urgently step up implementation and roll out of WHO guidance, especially in high-TB-burden countries, as this is vital for better outcomes for people affected by TB and to save lives.”
Stop TB Partnership. Step Up for TB 2020 - A survey of prevention, testing, and treatment policies and practices. http://www.stoptb.org/suft/. Accessed on Nov. 16, 2020.