Facing TB in Houston

WVM Implementing Community TB Program Interventions In Dowa

The World Vision Malawi (WVM) is leading partners in implementing Community TB Program interventions in all the districts of the country including Dowa targeting the general population.

The organization said with its partners, it will support the community volunteers who will be key in screening all people suspected to have Tuberculosis (TB) and collect sputum for diagnosis at the health facilities.

WVM's Global Funds Grant HIV/AIDS Specialist Buthelezi Mvula, said the program will strengthen the community sputum collection points and provide enablers for volunteers to motivate them and ease their voluntary work being done in the communities.

Mvula said the overall goal of the Community TB program interventions are aimed at reducing TB incidence rates (to 97/100,000 people) as well as reducing TB mortality rates (to 5/100,000 people) by 2027. He said the program will also target people living with TB patients and their families through case finding approaches-Community Sputum Collection Points and house to house to make sure that all targeted people are reached out. The Specialist said the program will conduct an annual coordination meeting with Prison leadership and community leaders to address comprehensive Prison TB care by emphasizing post-release care to minimize interruptions and focusing on efforts to reduce stigma and violence. He said the program will support stakeholders to train selected TB and DRTB supervisors on post-TB care and adherence support, TB awareness and health promotion, stigma and discrimination as well as training volunteers to enhance their capacity in the implementation of active case finding (House to House) to increase TB case detection. "The program has standardized package of enablers such as plastic table, plastic chairs, bicycles, sputum collection box, buckets with taps of 25L, gum boots, T-shirts, Black packs and provision of soap," said Mvula. He said the program will be implemented through its collaborative partners such as the Ministry of Health through National TB and Leprosy Elimination Program (NTLEP), District Councils, District Health Officers, District CSO Networks and Community Health Workers. World Vision Malawi alongside with its partners will implement Community TB Program interventions under the approved $21 million Grant

India's Tryst With Tuberculosis: A New Paradigm-BPAL Regime

Tuberculosis (TB) continues to be a major public health challenge in India, which bears the world's highest burden of the disease. Despite several government initiatives and advances in medical technology, managing TB in India is a complex task due to a variety of factors that are unique to the country's social, economic, and healthcare landscape. Here are some of the key challenges that India faces in its fight against TB:

High TB burden and drug-resistant TB

India accounts for over a quarter of the global TB cases. In 2022, there were an estimated 2.8 million TB cases in India. The sheer volume of cases makes it difficult to implement effective surveillance, diagnosis, and treatment programs across the country. Compounding this issue is the rising incidence of drug-resistant TB (DR-TB), including multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB.

MDR-TB in India is increasingly common, with over 130,000 cases estimated annually.

The emergence of XDR-TB adds another layer of complexity, as these strains are resistant to nearly all available anti-TB drugs, making them more challenging and expensive to treat.

Delayed diagnosis and underreporting

Early diagnosis is critical to controlling TB, but India faces significant hurdles in this area:

Access to diagnostics: Many rural and remote areas lack proper healthcare infrastructure, limiting access to advanced diagnostic tools such as GeneXpert machines and other molecular tests that can rapidly detect TB and drug resistance.

Underreporting: Many TB cases remain undiagnosed and unreported, especially in the private healthcare sector, which caters to a large portion of India's population. Patients often go undetected, are misdiagnosed, or do not receive proper follow-up. The stigma associated with TB also discourages people from seeking timely medical attention, further contributing to underreporting.

Poor Treatment Adherence and Completion Rates

The treatment of TB, especially drug-resistant TB, requires prolonged and complex regimens. Standard TB treatment involves taking multiple antibiotics for at least 6 months, while MDR-TB treatment can take up to 18-24 months.

Non-Adherence: Due to the long treatment duration, many patients fail to complete their course of therapy, either due to side effects, social factors, or a lack of understanding of the importance of adhering to the regimen. This non-adherence increases the risk of treatment failure, relapse, and the development of drug resistance.

Healthcare infrastructure and accessibility

India's healthcare system is a blend of public and private sectors, with vast disparities between urban and rural areas. In rural regions, where nearly 70% of the population resides, healthcare facilities are often under-resourced, and access to specialized TB care is limited.

Urban-rural divide: While cities may have better healthcare services, rural areas face a scarcity of diagnostic facilities, skilled healthcare workers, and access to second-line drugs required for treating MDR-TB.

Infrastructure gaps: Many primary healthcare centers are not equipped to handle the complexity of TB management, especially when it comes to managing MDR-TB, leading to diagnostic delays and inappropriate treatments.

Stigma and social barriers

The stigma associated with TB remains one of the most significant challenges to managing the disease in India. TB is often viewed as a disease of the poor, leading to widespread discrimination.

Discrimination: Many patients face stigma in their communities, workplaces, and even within families, which can result in social isolation and reluctance to seek care.

Impact on women: TB carries a disproportionate social burden for women in India, as it affects marriage prospects, family life, and employment opportunities. Many women delay seeking treatment to avoid being stigmatized, exacerbating the spread of the disease.

Co-infection with HIV

HIV co-infection is a significant risk factor for the development of active TB. In India, HIV-TB co-infection is a growing concern, particularly because TB is the leading cause of death among people living with HIV.

Co-infection burden: An estimated 3% of TB patients in India are co-infected with HIV, and this co-morbidity poses diagnostic and therapeutic challenges, as immunocompromised individuals are more likely to progress to active TB and require more complex treatment.

Private sector involvement

A significant proportion of TB patients in India first seek treatment from private healthcare providers, which are not fully integrated into the national TB control programs.

Unregulated treatment: In the private sector, there is often unregulated and inappropriate use of antibiotics, leading to improper treatment, poor adherence, and the development of drug resistance.

Delayed notification: Many private practitioners fail to notify the government about TB cases, leading to gaps in the overall data on the disease burden and treatment outcomes.

Financial constraints

Although the Indian government provides free TB treatment through the National Tuberculosis Elimination Programme (NTEP), the indirect costs of the disease remain a heavy burden on patients, especially those from low-income backgrounds.

Loss of income: Many TB patients, especially those with MDR-TB, are unable to work during treatment, leading to financial hardships that hinder their ability to complete therapy.

Cost of diagnostics and medicines: Although treatment is free in the public sector, many patients initially seek care from the private sector, where they may incur significant costs for diagnosis and treatment.

BPaL regime

What is MDR-TB?

Multidrug-resistant tuberculosis (MDR-TB) occurs when the bacteria that cause TB develop resistance to the two most powerful anti-TB drugs: isoniazid and rifampicin. This means that standard treatments no longer work, making MDR-TB far more challenging to cure. Patients with MDR-TB must undergo a long and complex treatment involving multiple drugs, often leading to severe side effects and poor adherence.

What is the BPaL regimen?

The BPaL regimen is a newly developed treatment specifically designed to combat MDR-TB. It consists of three drugs:

Bedaquiline (B): A new anti-TB drug that targets the bacteria's energy production, weakening and killing the bacteria.

Pretomanid (Pa): A drug that attacks the bacteria's cell wall and DNA, stopping its growth and leading to cell death.

Linezolid (L): A powerful antibiotic that blocks protein synthesis in the bacteria, preventing them from multiplying.

Together, these drugs work in synergy to provide a highly effective treatment for patients with MDR-TB, including those with extensively drug-resistant TB (XDR-TB).

Why is the BPaL regimen important for India?

India has one of the highest burdens of TB in the world, and drug-resistant TB is a growing challenge. Traditional treatment regimens for MDR-TB are long, lasting up to 24 months, and involve a complex mix of drugs with severe side effects. Many patients struggle to complete these treatments, leading to incomplete cures, further resistance, and spread of the disease.

The BPaL regimen is a game changer for several reasons:

Shorter duration: The BPaL regimen lasts only 6 months, compared to the traditional MDR-TB treatments that take up to 2 years. A shorter treatment duration makes it easier for patients to complete their therapy, increasing the chances of cure.

Fewer drugs: Older MDR-TB regimens require patients to take multiple drugs daily, often leading to difficult side effects such as nausea, hearing loss, and kidney damage. The BPaL regimen involves just three drugs, making it more manageable and less toxic for patients.

Higher cure rates: In clinical trials, the BPaL regimen has demonstrated cure rates of around 90%, which is significantly higher than those seen with older MDR-TB treatments. This means that more patients have a better chance of successfully overcoming MDR-TB.

Addresses XDR-TB: Extensively drug-resistant TB (XDR-TB) is an even more severe form of TB that is resistant to many of the most effective drugs. The BPaL regimen offers a powerful option for treating XDR-TB, a crucial step forward in fighting the disease.

The impact of BPaL on public health in India

Implementing the BPaL regimen widely in India could have a transformative effect on the country's efforts to control TB. By providing a shorter, more effective treatment for MDR-TB, BPaL can help reduce transmission rates, as patients who are cured more quickly are less likely to spread the disease. Moreover, improving treatment outcomes for MDR-TB patients will help prevent the development of more severe forms of drug-resistant TB.

Challenges to overcome

While the BPaL regimen shows great promise, there are challenges that must be addressed for it to have a widespread impact:

Cost: The newer drugs in the BPaL regimen, particularly bedaquiline and pretomanid, are more expensive than traditional TB drugs, posing a barrier to accessibility in low-resource settings.

Access: Ensuring that patients across India, particularly in rural areas, have access to the BPaL regimen will require strong government support, partnerships with health organizations, and an efficient supply chain.

The way forward

For India to make significant progress in the fight against TB, it is critical to embrace innovations like the BPaL regimen. Continued investment in TB control programs, improved diagnostics, and expanded access to effective treatments will be essential. Public awareness campaigns must also educate communities on the importance of completing TB treatment to prevent the spread of drug-resistant strains.

In conclusion, the BPaL regimen offers a vital opportunity to improve the treatment of drug-resistant TB in India. Its shorter duration, higher efficacy, and ability to treat even the most resistant strains of TB make it a crucial tool in the battle against this deadly disease. By making the BPaL regimen widely available, India can take a major step toward controlling and eventually eradicating TB.

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Views expressed above are the author's own.

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€80m Spent On TB Control This Year

The cost of the TB eradication programme to farmers and taxpayers this year passed the €80m mark before the end of August.

New Department of Agriculture figures show that the State's spend hit €54.8m by 27 August, by which time the farmer spend on TB testing stood at an estimated €26.2m in additional costs.

The Department figures indicate that vets have received €35.2m in farmer and Department payments for TB testing to date this year, three-quarters of which was paid for directly by farmers. This surpasses the total sum of all farmer compensation payments for TB as only 41c out of every €1 spent on TB – or €33.6m – found its way to the farmers dealing with disease outbreaks.

The cost of the TB eradication programme to farmers and taxpayers this year passed the €80m mark before the end of August.

New Department of Agriculture figures show that the State's spend hit €54.8m by 27 August, by which time the farmer spend on TB testing stood at an estimated €26.2m in additional costs.

The Department figures indicate that vets have received €35.2m in farmer and Department payments for TB testing to date this year, three-quarters of which was paid for directly by farmers. This surpasses the total sum of all farmer compensation payments for TB as only 41c out of every €1 spent on TB – or €33.6m – found its way to the farmers dealing with disease outbreaks.

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