Addressing the Persistent Threat of Tuberculosis
Tuberculosis (TB) is one of the major public health threats worldwide, competing with the human immunodeficiency virus (HIV), and now even the Covid-19 virus, as the major cause of death due to infectious diseases. To understand the current status of TB and multi drug-resistant tuberculosis (MDR-TB), discuss recent advances in TB research and control, and address the impact of the Covid-19 pandemic on TB in India and Kenya, Columbia Global Centers | Mumbai, in collaboration with Columbia Global Centers | Nairobi, organized a virtual panel discussion with leading experts on the topic on November 30, 2021.
The continuing spread of drug-resistant tuberculosis is one of the most urgent and difficult challenges facing global TB control today. Dr. Neil Schluger, Adjunct Professor of Epidemiology at Columbia University’s Mailman School of Public Health, presented the challenges of MDR-TB, discussed patient outcomes, elaborated on various methods and techniques of rapid TB detection, and elucidated different treatment regimens for patients of MDR-TB. Presenting findings from various clinical trials, Dr. Schluger suggested a slew of measures for improving treatment for MDR-TB, which included building capacity in clinical trials and strengthening health systems through prompt detection of drug resistance, implementing well-functioning TB control programs, and ensuring adequate drug supply in high-risk regions and countries around the world.
In Kenya, TB is the fourth most common cause of mortality. Kenya is, in fact, ranked 15th among the 22 high-burden countries that collectively contribute about 80% of the world’s TB cases. Dr. Irene Mugenya, Clinical Manager-Kagemi/Trial Physician in Kenya, traced the epidemiological landscape and elaborated on key risk factors in Kenya such as diabetes, undernourishment, HIV, smoking, and alcohol use. Describing the transmission of TB in HIV-prevalent settings in Kenya, she talked about TB/HIV co-infection and Antiretroviral Therapy initiation in certain parts, and shed light on the Kenyan government’s commitment and efforts against the deadly disease. While addressing mechanisms for reducing the burden of TB in Kenya, Dr. Mugenya proposed creating more awareness about the disease, sensitizing the community, improving patient education, training healthcare workers in sample collection, and allocating more funds and resources as a few possible solutions.
Closer to home in India, which contributes approximately 21% of the total global TB cases with 2 million new cases added every year, the Covid-19 pandemic has severely affected TB mitigation and treatment efforts. In 2020, for the first time in two decades, mortality from TB increased instead of showing a decline, remarked Dr. Ravindra Dewan, Director of National Institute of Tuberculosis and Respiratory Diseases, New Delhi. The severe economic impact of Covid-19, disproportionate allocation of healthcare budgets for Covid-19 and poor diagnosis have all proven to be detrimental to TB detection and treatment, he elaborated. However, some synergies in human resources allotment (at the national, state and district levels), diagnosis (such as decentralizing lab testing, increasing testing capacity, supporting institution-based screening, contact tracing using mobile apps), and treatment (such as awareness activities focused on infection, prevention, and control) have helped in managing the TB situation in India to some extent in some parts of the country. Dr. Dewan suggested augmenting research in the development of TB vaccination, promoting early diagnosis and treatment of latent tuberculosis, and identifying measures in the prevention of development of TB-drug resistance to fight the TB battle in India.
Speaking to a global multi-stakeholder audience, the panelists agreed that while TB has been a major public health concern — and the Covid-19 crisis has severely disrupted TB services worldwide — affected countries can still fight this disease if the right steps are taken to increase overall screening and testing capacity, implement strategies for easy identification of TB hotspots, ensure uninterrupted drug supply for treatment through effective planning, improve research funding for treatment, and use advanced diagnostic technologies.