Trading indifference on the triggers of TB is amplifying the burden globally

Roger Paul Kamugasha, CNS Correspondent, Uganda
As we applaud the effort of global players in the fight against TB for the immense resources invested to end TB by 2030, let me, as a TB activist, strongly grieve because of the persistent and pseudo ignorance exhibited  by our global planners. This year’s Global Theme is “Unite to End TB” with the slogan of “Find the Missing Patients with TB”. I find these appropriate and concur with the phrasing. It is in black and white that about 9 million people get TB every year around the world and nearly 2 million deaths are caused by TB alone. This means with every passing minute, 3 persons die of TB and it is  also the leading killer among HIV infected people, responsible for the 30% deaths of HIV positive people.

Science alone cannot end TB, and medicalizing the disease to the extent of side-lining communication practitioners will only exacerbate the TB burden. A decade ago, global health players in the TB sector were engrossed with the perception that information, education and communication activities for behaviour change are not measurable;  meaning spending on advocacy communication and social mobilization (ACSM) was a wastage of resources. Unfortunately this perception still exists as we devise innovations to achieve SDGs. We kept a steadfast gaze as our counterparts in the malaria and HIV implementation were vigorously investing huge sums of money into billboards and awareness vans; their ACSM is indeed up to now not underrated. This led to raising the profile of these two diseases, leaving TB stuck somewhere in the desert with continued duplication of strategy. I do believe this is one  of the reasons why TB has always had smaller budget proposals submitted to the Global Fund as compared to the other two.

An organization called PATH, which is based in USA, seemed to have recognized the importance of behavioural change initiatives. They went ahead to develop ACSM tools and trained advocates from all over the world in ACSM in the control of TB. It has taken a while for the rest of the world  to buy into this, yet it is one of the neglected causes of the escalating TB burden. People are lost to follow up, and poor adherence leads to resistant strains where patients develop multi drug resistant TB (MDR-TB) and are moved to second line drugs. The majority of these patients do not have even the least information about the importance of treatment adherence or consequences of failing to comply. The key organizations that have been at the forefront of TB priorities, need to refocus and massively highlight the plight of ACSM gap. Once again, I do applaud the efforts of the Stop TB Partnership under the leadership of Dr. Lucica Ditiu for prioritizing ACSM as key to ending TB at all levels. Partners  like Stop TB Partnership, ACTION, the recently formed Global TB Caucus,  and German NGO DSW are counted on to take up this fundamental aspect.

The Berlin TB Summit call for G20 leaders to prioritize TB in their agenda, ahead of the G20 Summit in July this year, is a paradigm shift for focusing on TB research. In Sub Saharan Africa there are about 8,600 new HIV infections among adolescent girls and young women (AGYW) every week. The Global Fund's  new strategy for 2017-2022 places increased emphasis on reaching this group, including measuring HIV incidence among women aged 15-24 years as a key performance indicator. To  achieve its objectives, an additional USD 55 million, on top of country allocations, is earmarked for the scale up of HIV prevention among AGYW in the 2017-2019 funding cycle. Why not get advocacy for TB on board as well? There is need for the Global Fund to break the ice about ACSM as a key component in ensuring that all the missing cases are found and treated. They can begin by placing ACSM in catalytic funding. As advocates, we shall strongly push for this. We need to come up with an advocacy strategy- preferably a TB media agenda- on this widening gap. As global health advocates and ACSM practitioners, we have really made noise about ACSM priorities but our appeal falls on deaf ears. ACSM is a cross cutting necessity— from community to policy and global level— and should not be ignored anymore. If the world stubbornly ignores ACSM priorities, we are bound to keep incubating TB up to 2030 and far beyond.

Roger Paul Kamugasha, Citizen News Service - CNS
April 8, 2017

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