By Christian Benard

Tuberculosis (TB) stakeholders have called for quick start off of tuberculosis preventative treatment amidst rise in TB infections.

They were speaking at the 52nd Union World Conference on Lung Health which witnessed a notable concern by the Increasing Market and Public Health outcomes through scaling up Affordable Access models of short Course preventive Therapy for Tuberculosis (IMPAACT4TB).

“We know how to prevent TB and we have the tools at hand to prevent close contacts of people affected by TB from falling ill- and yet for the first time in over a decade we’ve witnessed an increase in the number of people dying from TB,” said prof. Gavin Churchyard, founder and Group Chief Executive Officer of the Aurum Institute.

“Not only am I devastated and saddened by this unnecessary loss of life, but I am also appalled by our moral failure to do better.”

According to the WHO Report, the targeted worldwide mission of providing 30 million people with tuberculosis preventive treatment for the period between 2018 to 2022 only a distant 29% has been achieved.

Similarly, 29% of household contacts under the age bracket of five and below have received tuberculosis preventive treatment with just 1.6% of household contacts ranging from five years and above having been taken care of.

On the other hand, it is worth noting that the target of reaching people living with HIV has been exceeded indicating an unequivocal attainment.
While the progress so far made in providing tuberculosis prevention to HIV victims is commendable, Director of Programs at the Global Health Initiative (UNITAD), Robert Matiru observes that we must remain focused on when efforts are lacking.

“Millions of people –including young children who are particularly vulnerable to TB- continue to go without access to TB prevention. We know how to avert needless TB disease but we need to see urgent action and resources committed to reach everyone at risk,” said Robert Matiru.

Other suitable options for tuberculosis preventive treatment have been developed to help cement the campaign against the disease with Malawi taking center stage in stepping up 3HP regimen that is recommended by Centers for Disease Control and Prevention (CDC) for treatment of latent Tuberculosis infection.

“Malawi recently announced the national scale up of 3HP- a shorter, safer alternative to older TB preventive treatment- for all people newly initiated on HIV treatment. This is a welcome development, and we hope to see more countries follow the Malawi government’s example. We also hope that such recommendations will soon be expanded to household contacts of people living with TB, including children,” said Emmanuel Kaonga, IMPAACT4TB project manager, KNCV TB foundation, Malawi.

It is through such rigorous formulations that eleven out of twelve Unitad-funded IMPAACT4TB consortium countries have started 3HP as Kenya, Zimbabwe, Malawi, Ghana, South Africa, Ethiopia and Mozambique having close to half of the people living with HIV already commencing tuberculosis preventive treatment.

The rollout of 3HP has however faced difficulties. The entry of covid-19 and its huge restrictions on staff movement in and out of the countries hindered delivery of products, provision of technical assistance, and verification of data, contact investigations and follow-ups.

Lockdown in several countries of the world highly limited traveling patterns of medical experts as well as other stakeholders in the health sector. Kenya for instance banned entry and exit of its borders during the early days of the corona virus – that was in April 2020 when the covid-19 graph elevated day by day.

What followed was a symbolic low level of service delivery of 3HP. In responding to the restrictions especially physical contact, virtual fora were initiated to help blend the new mode of operation. It called for a new adaptation as online switch kept knocking.

Large scale task-shifting of healthcare personnel and incorporation of tuberculosis and corona virus related activities resulted to a positive influence.
In addition, it is important for drug manufacturers to accelerate the acquisition of affordable drugs to all segments of the society so as to enable people to have these drugs at their disposal.

A well-orchestrated patient friendly plan to produce and deliver rifapentine for both adults and children will speed up the acceptance of such regimens in communities affected by tuberculosis. In taming the spread and effects of this disease, preventive treatment is the first and surest defense at hand.