Ending TB is a multisectoral assignment, not a one-person job

Alice Sagwidza-Tembe, CNS Correspondent, Swaziland
The world gathers every year on World TB Day to commemorate and celebrate the milestones achieved so far towards reversing TB trends. There has indeed been a continuous remodeling of consolidated interventions from 1994-2005 focusing on directly observed treatment short course (DOTS), to the Stop TB strategies during 2006-2015, and now for 2016 -2030 focusing on the End TB strategy, noted Dr Mario Raviglione, Director at Global Health Centre with the University of Milan.

During a webinar titled ‘Politics of TB in 2018: Multi-sectoral Accountability’, Dr Raviglione expressed that even though past interventions have succeeded averting a large number of TB deaths, the impact has not been enough to ebb the rising tide of TB. Unlike the response to HIV-AIDS, TB seems to have remained a clinical problem- to be responded to by clinicians and the departments of health- but in reality it is not so. TB is not only a medical problem, but it is also a social and economic, as well as political challenge, and to end TB all the facets need to play their part.

I had the opportunity of chatting with Nkosinathi Ndzinisa (name changed), a survivor of multi-drug resistant TB (MDR-TB), who is still fighting for compensation from his employer, twelve months since he was released from hospital. Nkosinathi was diagnosed with susceptible TB from a random symptomatic assessment during a workplace wellness session in early 2015.

“I was started on treatment the following week after referral to the national referral hospital, Mbabane Government Hospital, and after four months I felt worse than when I first went to the hospital. At six months, I had not recovered and was bedridden. Then I was referred to the National TB Hospital in Manzini and was diagnosed with MDR-TB. I was admitted and stayed in hospital on treatment for seven months after which I recovered at home. After two and half years I was ready to go back to work. But my eye sight and hearing had been compromised due to side effects of my TB medication and I was told my post was filled. I had received no notice of my termination.Three  months after I stopped going to work my salary was ceased, and I am still fighting for compensation. They replaced me like I was dead; it is unfair”, he said.

According to the WHO Global TB Report 2017, TB is still the top infectious disease killer. Ideally, this should have red flagged all hands on deck response, but evidently it has not. Until investors, companies and employers start realizing the urgency of the situation, soon there might be no healthy workforce to employ and be productive. If they keep folding their hands, the economy is in for a huge plunge. Then again, unless religious leaders and educational institutions realize the gravity, there will be no healthy people in places of religious worship and/or in schools. TB  would trickle through these gaps. Until governments proactively implement TB control programs, there might be no healthy workforce to tax, and no economic growth; countries will remain in perpetual desperation to avert TB and related morbidities.

Angela Makamure, Press Officer at MSF (Doctors Without Borders), Southern Africa, said that the five barriers to effective TB treatment are stigma; unidentified TB cases; toxic treatments for MDR-TB; lack of patient support systems; and slow pace of decentralising care for MDR-TB.

While conceding that health responses have achieved some significant goals for TB control, Dr Raviglione, insisted on focusing on the following systemic issues to avoid a repeat of the catastrophic deaths that TB has been accountable for thus far:

Poor living and working conditions: TB thrives in congregant and unventilated conditions. Decent housing as a basic need may seem far removed from TB, yet it is a major stepping stone for curbing the widespread of TB infection from one infected person to several others. At workplaces, particularly in manufacturing units, located in developing countries and commonly known a sweat shops, one infected person can result in multiple cases of TB.

Food security: There are still large malnourished populations and with that comes compromised immune systems and heightened predisposition to TB infection, as well as poor TB treatment outcomes. Eradicating malnutrition will play a major role in ending TB.

Stigma and discrimination: High prevalence of TB ad HIV co-infection, has also heightened self diagnosis and stigma. This results in patients going into hibernation and either not seeking healthcare at all or  irregularity in treatment intake. TB patients coming from elite class literally go into ‘witness protection’ mode as TB is still believed to be a disease of the poor. This in turn has hampered intensive case finding.

At risk populations: There are most certainly some populations who are more vulnerable than others. These include people with compromised immune systems, the underprivileged and the poor. The one size fits all approach will leave cracks that is likely to slow down the efforts to end TB.

David Mabuza, the South African Deputy President expressed at the 2018 World TB Day commemoration in KwaZulu Natal, that TB has been around for so long and complacency has developed in political and commitments. He called for high level leadership to stand up and lead the response, because TB is still alive, and still the number one killer in the world. ( https://youtu.be/vEWI8bmB0dM ) This is in consolidation with the theme of “Wanted: Leaders for a TB Free World”.

Alice Sagwidza-Tembe, Citizen News Service - CNS
April 5, 2018