Lung health beyond 2015: Is there a future?

Alice Tembe, CNS Correspondent, Swaziland
Photo credit: CNS:
As we usher in a new era for public health and social equity response globally, it is equally essential to look back and learn from the successes and failures encountered in the path that has been travelled so far, in order to enhance the strategies that worked, conclude targets that were achieved and rethink about methods that failed. Mr. Sibusiso Phungwayo (name changed), a teacher who is living with HIV and is a survivor of Multi Drug Resistant TB (MDR-TB), said that, “I knew I would live with HIV, but my worst fear was surviving TB.

When I woke up from what was supposed to be my deathbed on which I had been resting for nineteen month, I could not see clearly and could hear only faint sounds in my right ear, there was no future for me to imagine. TB seemed to have snatched away my visual and hearing capabilities.”

To make matters worse, Mr Phungwayo, lost his job. Even though he got spectacles to help with his sight and hearing aids, he was deemed unfit to work as a teacher. This stripped his family of their sole breadwinner, as he did not have any qualifications, other than his teaching diploma that could help him look for some alternative employment. He expressed gratitude to the Ministry of Health and the Government of the Kingdom of Swaziland for providing him free medication that saw him survive MDR-TB. However, he said that beyond being alive, his life post MDR-TB has proved to be hard.

As Dr. Riitta Dlodlo, Director of the Department of TB and HIV, International Union Against Tuberculosis and Lung Disease (The Union), from Zimbabwe highlighted, the journey for TB care and control has been long. Reminiscencing, she recalled the introduction of the Directly Observed Treatment Strategy (DOTS) in the early 1990s, that was specific for TB management at a time when there was no strategic link to HIV response. The next major milestone was the development of a 6 point Stop TB Strategy by WHO in 2006, that not only built upon the success of DOTS, but also addressed the key challenges facing TB. This included scale-up of collaborative TB-HIV activities and prevention and management of MDR-TB. Thus collaboration between national TB and HIV response strategies was initiated, as by then it had been acknowledged that TB is a double edged sword that hung over the lives of over a third of the approximately 34 million people living with HIV globally to date according to the WHO Report.

The new post 2015 End TB Strategy, with its ambitious target to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, also prioritizes the TB-HIV response strategy. Aware that HIV coinfection is the main reason for the failure to meet TB control targets in high-HIV prevalence settings and that TB is a major cause of deaths among people living with HIV, it recognizes the need for enhanced joint action in addressing the dual epidemics of TB and HIV/AIDS through increasing integration of primary care services in order to improve access to care.

Unfortunately these years also saw the graduation of drug sensitive TB to drug resistant TB and the growing co-epidemic of diabetes in both developed and developing countries. A report published by The Union in 2014, indicates that diabetes triples the risk of TB development. Consequently, the globally increasing prevalence of diabetes is a real threat to the milestones achieved by TB and TB-HIV interventions-- this is a cause for concern.

Post 2015 is witnessing the deadline of the Millennium Development Goals and, come September 2015, the global health community will begin grappling with the agenda of the Sustainable Development Goals. At this critical juncture discussions need to focus upon the following:

• Establishing a new strategy for pediatric TB, with short term and better tasting and child friendly doses as noted by Joanna Breitstein, Senior Director (Communications), TB Alliance
 • Reinforcing collaborative response strategies for TB and other co-infections, like HIV and diabetes rather than adopting the silo approach
 • Standardizing inter-governmental treatment protocols to manage treatment and care of mobile populations exposed to TB
 • Making available affordable diagnosis, short treatment regimens and adherence monitoring systems for MDR-TB, especially in resource limited circumstances
 • Addressing the workplace TB exposure risk factors for populations like healthcare workers and mine workers.

Alice Tembe, Citizen News Service - CNS 
4 August 2015