CNS

Community volunteers making a difference in addressing TB and HIV

Lwin Lwin Thant, Myanmar
Had it not been for community volunteers, a person co-infected with TB and HIV would not have been able to get proper care in Myanmar. When the thin and faded seventy years old mother asked, "Mg Swe…..How are you feeling today?". Mg Swe, lying in bed and writhing with pain, answered "I am alright, A May (Mum)." Mg Swe is a 46 years old, single man who has only one leg. He joined the army in 1985 out of despondency due to his parents’ divorce. Four years later, when there was the sea-island battle with Kayin People in Tanitaryee Division, he lost his left leg in that war.

Lwin Lwin Thant, Myanmar
[Lwin Lwin interviewed a person living with HIV, drug-resistant TB and Hepatitis B Virus in Myanmar. She is presenting the story as was told to her below]
“Ma Mya!.. Ma Mya!.. Ma Mya!” I heard my name being called out loud and impatiently from the street while I was busy with housekeeping for my family. Worried, I rushed out of my house and found a nurse from the township medical clinic waiting for me.

World Pneumonia Day is observed on 12 November every year since 2009 to bring awareness to this leading killer of children below 5 years of age. An editorial in this month’s International Journal of Tuberculosis and Lung Disease (IJTLD) highlights that pneumonia is a lung disease that affects not only children but people of all ages. Authors Dr Stephen Graham of The Union and Prof Guy B Marks, IJTLD Editor-in-Chief for Lung Disease, write that “pneumonia has been an important cause of death for centuries”.

Carolyn Kavita Tauro, India
It was a casual sit-in with some of my friends back home when one of them who is a mother of a three-year old boy said to me, “Hey tell me! As soon as I get to know that one of my son’s friends is ill, I already give him some antibiotics so that he doesn’t get ill… is this ok”? By the time she had asked me the question, she had realized that maybe it was not ok for her to do it, but like most people she did not know why. Another young mother quickly adds, “But anyway the doctor give so many medicines nowadays”.

Alice Tembe, Swaziland
It is common labour practice that sick leave is fourteen days with full pay, followed by another fourteen days of half pay and thereafter, it is unpaid leave. This made practical sense about a decade if not more years ago. With the rising toll of TB, industries lose on average an estimated thirty days to six months of paid sick leave a year, when one staff member gets infected with TB. The productivity time lost is becoming even greater, with MDR-TB. In the interest and respect of human rights, most industries are failing to control and manage productivity in the face of this dreaded disease.

The air around us has been riddled with so much of dirt that it is increasingly becoming unfit for consumption. And yet we cannot survive if we do not breathe. The theme of the 44th Union World Conference on Lung Health organised by the International Union Against Tuberculosis and Lung Disease (The Union) held recently in Paris was very apt - 'Shared air, safe air?'

India has the world's third-largest population of people living with HIV (PLHIV) - 2.4 million. However, it has been able to make significant progress in recent years by thinking out of the box. This has led to a decline of 50% in the number of new infections over the past decade. For a country that UNAIDS once feared could eventually house the largest number of persons living with HIV, this is a big feat.

A young scientist was awarded the third prize at Falling Walls Labs 2013 for her research aimed to reduce mortality and complication rate in surgical procedures to treat cardiovascular diseases (CVDs). According to the World Health Organization (WHO), CVDs are the number one cause of death globally (30% of all global deaths are attributed to CVDs). "Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke" said Dr Rishi Sethi, Associate Professor, Department of Cardiology, King George's Medical University.

Okeoghene Oghenekaro, Nigeria
(First published in News Agency of Nigeria (NAN), on 30th October 2013)
The 2013 WHO Global Tuberculosis Report says an estimated 450,000 people develop Multi-Drug Resistant to Tuberculosis (MDR-TB). MDR-TB is a form of TB that is resistant to at least two drugs known as ``rifamoicin’’ and ``isonaizid’’, which are the two most powerful first line treatment of tuberculosis. The report however said that globally 170,000 died from the disease in 2012.

At the close of the 44th Union World Conference on Lung Health, held in Paris, the International Union Against Tuberculosis and Lung Disease (The Union) announced that it has received US $48 million in new funds for TB control in some of the world’s hardest-hit countries and to continue critical areas of operational research. The Global Fund pumped in US $40.05 million for the Union’s TB control activities in India (Project Axshya) and Myanmar (PICTS); while the USAID renewed funding of US $8.30 million for the TREAT TB initiative of the Union. The two together amount to a funding of US $48 million.

L-R: Dr Swarup Sarkar, Dr Santhosh Matthew,
Ganesh Ramakrishnan, Lov Verma,
Dr M Suresh, Dr Sundararaman, Taufik Bakkali

Sumita Thapar - CNS
Learnings from Project ORCHID's pioneering work on harm reduction in northeast India shows that scale up is possible even in resource poor and conflict ridden settings. A national dissemination workshop organized by Project ORCHID in Delhi saw sharing and discussion on best practices on harm reduction: reducing HIV risk among injecting drug users (IDUs).

Shobha Shukla - CNS
(Based on an exclusive interview given to CNS by Dr Mao Tan Eang, NTP Manager, Cambodia, during the 44th Union World Conference on Lung Health)
Cambodia, with a population of 15 million, is one of the 22 high TB burden countries. It has implemented two national TB prevalence surveys, during the last 10 years—one in 2002 and the other in 2011.The repeat survey provided robust evidence of a decline in TB burden in Cambodia, following DOTS (Directly Observed Treatment Short course) expansion in 2002. Results indicate a 45% reduction in the prevalence of bacteriologically-confirmed cases over a period of only 9 years since the first survey conducted in 2002. This amounts to an annual decrease of over 4.5% which is quite remarkable as compared to the global average of 2%.

Shobha Shukla - CNS
(As told by her to CNS during the 44th Union World Conference on Lung Health held in Paris)
My name is Xolelwa Joni and I am 26 years old. I come from Cape Town in South Africa. After finishing my secondary school education I did a course in information technology. In my family I have my 85 years old father, my 63 year old mother, my 32 years old elder sister, a younger 11 year old brother and my twin sister from whom I contracted MDR-TB. All of us live together in a two roomed house.

The International Union Against Tuberculosis and Lung Disease (The Union) issued a position statement at the 44th Union World Conference on Lung Health in Paris, warning about the potential health impact of e-cigarettes (ECs) and electronic nicotine delivery systems (ENDS). The statement which was developed by a panel of health experts, based upon a comprehensive review of all the available scientific evidence on the use of ECs and ENDS, calls for urgent regulation of these products.

There is evidence of an important association between diabetes mellitus (DM) and tuberculosis (TB). DM increases the risk of active tuberculosis by a factor of 2 to 3. Also people with TB, who have diabetes, have been found to have worse TB treatment outcomes. The WHO - The Union (The International Union Against Tuberculosis and Lung Disease) Framework for Collaborative Activities recommends bilateral screening for TB and Diabetes -- screening for active tuberculosis in patients with diabetes and for diabetes in patients with TB in order to make earlier diagnoses, which in turn may lead to better treatment outcomes and control of both diseases.

Shobha Shukla - CNS
According to the World Health Organization’s Global Tuberculosis Report 2013, India has the highest incidence of TB in the world, with 2.2 million new TB cases annually which amount to 18% of the global TB burden and 66% of that in South East Asia. India also has 31% of the global total of missed cases of 3 million. In addition, out of the 22 high-burden countries, India saw the greatest increase in multidrug-resistant (MDR-TB) between 2011 and 2012. There were an estimated 64000 cases of MDR-TB in 2012, over 25% (16588) of which were diagnosed with the disease and 14143 were put on treatment.

There is no doubt that investment and thrust for more effective new diagnostic and treatment tools for tuberculosis (TB) must go up but alongside it is equally imperative to optimally use existing technologies. "Innovation has the ability to change the world. Innovative approaches lead us to concrete outcomes as opposed to knowledge for knowledge sake. We need new ways of doing things. It is trying to solve a problem as opposed to generate new knowledge [by doing research]" said Dr Mel Spigelman, President and CEO of Global Alliance of TB Drug Development (TB Alliance) at the 44th Union World Conference on Lung Health. "We do not optimally use all the resources we have currently."

World Pneumonia Day: 12 November 2013
Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Dr Stephen M Graham of International Union Against Tuberculosis and Lung Disease (The Union) said at the 44th Union World Conference on Lung Health in Paris that children can be protected from pneumonia – it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care. An alarming number of deaths due to childhood pneumonia continue to take place in countries such as India and China.

Shobha Shukla - CNS
While the number of people detected with MDR-TB increased to 94,000 globally in 2012 (by more than 40%) this amounts to less than 20% of those actually estimated to have MDR-TB. Even amongst the lucky few who did get diagnosed, almost 17, 000 of them could not be put on treatment for a variety of reasons: lack of political commitment, inadequate financing, bottlenecks in uninterrupted drug supply, human resource shortage - to name a few. Failure to test and treat all those with MDR-TB not only has grave consequences for those affected but also poses serious public health risks.

Sam Banda Jnr, Malawi

Malawi’s National Tuberculosis Programme (NTP) Programme manager James Mpunga says the problems of multidrug-resistant TB (MDR-TB) is a challenge to the Southern African country compared to Extensively-Drug Resistant TB ( XDR-TB), observing that it is high time new vaccines were developed. He said that with patients not always taking the drugs as directed, MDR-TB and XDR-TB strains have emerged. Mpunga, nevertheless, discloses that Malawi has a problem with MDR-TB and not XDRTB yet.

Diana Esther Wangari - CNS
MDR-TB is a form of TB that is resistant to at least the medicines rifampicin (R) and isoniazid (H). This makes it more difficult and expensive to treat. Compared to six months for a typical TB case, it can take up to two years to treat MDR-TB and the treatment is 100 times more expensive. Proof of the efficacy of shorter treatment regimens would signal real progress in helping to reduce the time and cost of addressing some cases of MDR-TB and this topic is addressed in several sessions during the conference.

Shobha Shukla - CNS
According to the recently released WHO Global TB Report 2013, 450,000 people fell ill with multidrug-resistant TB (MDR-TB) and 170,000 died from the disease in 2012 alone. China, India and the Russian Federation have the highest burden of MDR-TB followed by 24 other countries. Although the number of people detected worldwide with rapid diagnostic tests increased to 94,000 in 2012, three out of four (75%) MDR-TB cases still remain without a diagnosis. Also, just over 77,000 (82%) of these 94,000 people with MDR-TB were started on second-line treatment in 2012.

Bobby Ramakant - CNS
"2013 has been a year of tremendous progress. I am optimistic that paediatric TB will no longer be 'the neglected of the neglected'. With help of UNITAID and US Agency for International Development (USAID) we are embarking on significant changes in this direction” said Dr Melvin Spigelman, President and CEO of Global Alliance of TB Drug Development (TB Alliance). He was addressing the TB Alliance Stakeholders’ Association Annual meeting before the 44th Union World Conference on Lung Health opens in Paris later this week.

Citizen News Service (CNS) will facilitate a small team of correspondents to provide issue-based and thematic coverage from the forthcoming 44th Union World Conference on Lung Health in Paris, France. To get CNS conference reporting from the 44th Union World Conference on Lung Health, please join the Global Stop-TB eForum or follow us on Twitter (@bobbyramakant, #LungHealth) or on Facebook or visit us online. If you are attending this Union conference, please be welcome to get interviewed by one of CNS correspondents. To coordinate, please email CNS Managing Editor Shobha Shukla.

Globally around 300 million people suffer from asthma, yet for many of them living in low- and middle-income countries access to quality-assured, affordable asthma essential medicines still remains a distant dream. This was revealed in a study conducted by Dr Zaheer Babar from the School of Pharmacy at the University of Auckland and Dr Karen Bissell from the University’s School of Population Health and International Union Against Tuberculosis and Lung Disease (The Union), and published in the journal PharmacoEconomics.

Personal Stories of Women and Transgender with TB/ MDR-TB/ TB-HIV

Personal stories of women and transgender with TB/ MDR TB/ TB-HIV

Voices From The Field: Need to make TB programmes gender sensitive

Voices from the field: Need to make TB programmes gender sensitive

Children: The Innocent Victims Of Adult Follies

Shobha Shukla - CNS
It is estimated there are more than 5 million people sick with multi drug-resistant TB (MDR-TB) in the world today, which afflicts approximately 440,000 people each year, including children. Likewise, 35.3 million people are living with HIV out of which 3.3 million are children. Most of these children acquire the virus from their HIV-infected mothers during pregnancy, birth or breastfeeding, while poverty, weak immune systems, malnourishment, HIV, and maternal TB make children more vulnerable to getting TB from infected adults. 74, 000 children succumb to TB every year while AIDS related paediatric deaths are 230,000.

Shobha Shukla - CNS
India has certainly come a long way forward in its response to providing access to standard WHO recommended anti-TB treatment through Directly Observed Treatment Short course (DOTS) to more than 14.2 million (1.42 crores) people across the country. Yet TB continues to remain one of the key public health priorities in India with Multi Drug-resistant TB (MDR-TB) becoming a major concern.

Chhatra Karki, Nepal
(First published in Kapan Online, Nepal, 14 October 2013)
The ‘Roadmap for childhood TB: Toward zero deaths’ brought out by the International Union against Tuberculosis and Lung disease (The Union), World Health Organization (WHO), Stop TB Partnership and other institutions, has not come a day too early. It is indeed high time for countries to prioritise implementation of childhood TB programmes and take effective steps to prevent this curable disease from taking the lives of 72,000 children around the globe each year.

Despite challenges of health systems and the biggest TB disease burden globally, India has certainly come a long way forward in its response to providing access to standard WHO recommended anti-TB treatment through Directly Observed Treatment Short course (DOTS) to more than 14.2 million (1.42 crores) people across the country. Yet, despite successes TB continues to remain one of the key public health priorities in India.

Alice Tembe, Swaziland
The Global Childhood TB Roadmap was released on the 1st October 2013 in Washington DC, calling for doubled efforts in research, mainstreaming and commitment to combating TB deaths among children under the age of 15 years. It is notable that with the growing burden of the disease coupled with HIV-AIDS, the focus to find a cure, a prophylaxis and better management drugs could have overcome the need to address children’s needs.

Shobha Shukla - CNS
It was a indeed a humbling experience for me to meet Ajay, a middle aged graduate from Muzzafarnagar, UP. Ajay was one of the rare cases of extensively drug resistant TB (XDR-TB) who had tested negative, but was still under treatment, and recovering in the MDR-TB Ward of Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), New Delhi, when I spoke to him (or rather he insisted that he speak to me) in February, 2013. He was very keen to share his agonizing experiences with the rest of the world so that others would not suffer the same fate as his due to ignorance about diagnosis and treatment of TB.