According to the Step Up for TB 2020 report, millions of people are still diagnosed and treated based on outdated policies and using old tools and approaches - impacting the TB response and achievement of the UN's TB targets agreed by heads of state in 2018.
The report reveals both progress and shortcomings in the alignment of national tuberculosis (TB) policies with the latest international recommendations. The Stop TB Partnership (STBP) report finds that significant policy gaps risk undermining progress in the fight against one of the world's leading infectious killers. And the situation that is worsened by the negative impact of the Covid-19 pandemic on people affected by TB.
In response to the Covid-19 pandemic, countries around the world have reportedly adopted new laws and policies to prevent its spread, often at unprecedented speed. Yet, when it comes to TB policy, gaps are undermining progress against the top infectious killer in low- and middle-income countries. The new report calls on countries to urgently update their TB policies and recommendations as a crucial first step towards ensuring the funding, scale-up and implementation of comprehensive TB responses.
"None of us would like to be diagnosed and treated with things that are outdated and old. We would all want to have access to the latest things, right? With Covid-19 every day there are things happening so we need to arrive there with TB as well. There are a lot of resources online because there was a large group of colleagues that developed these resources to see from this report, per region and per country, which kind of policies are in place, which kind needed to be updated."
"Basically the report looked at diagnosis for TB, treatment, preventive treatment as well as procurement of medicines. In each of them, there are things that are progressing very well and you could see changes but there are things that are still not so great and in diagnosis, for example, it's amazing that we have 80% of the countries moving to Rapid Molecular Diagnosis," Dr Lucica Ditiu the Executive Director at Stop TB Partnership.
The report examines the national policies of 37 countries with a high burden of TB, assessing the extent to which they align with World Health Organization (WHO) guidelines and international recommendations. With an estimated 7.7 million people developing TB each year, these 37 surveyed countries represent 77% of the global TB burden and 74% of the estimated burden of drug-resistant TB.
"It's not yet at scale but the policy is there in 80% of them - just 6 of the 37 countries are saying they are waiting for Universal Drug Sensitivity Tests to be available. So a large proportion of people are still starting treatment with medication that they are not sure works. The same for people with HIV, the diagnosis for TB can be done very simply and quickly using a test called lipoarabinomannan assay (LAM) from urine, which WHO recommended since 2015. Five years later we have a very small proportion of countries that are really not promoting this tool that is very easy to use," said Dr Lucica Ditiu, the Executive Director at Stop TB Partnership.
"On the treatment, it's very important that we've moved away from the injectables. Basically everyone now should have access to treatment that is oral-based, especially for drug-resistant TB. We still have around 30% of the countries that we surveyed that haven't changed their injectables policy yet, this is why together with our partners we are calling for a change in this policy in such a way that by World TB Day which is in March 2021 all these countries will have changed their policies to exclude injectables as treatment for Drug resistant-TB," Ditiu said.
According to Stop TB Partnership, after decades of neglect, TB prevention has finally been recognized as a priority area in the fight against TB. Systematic screening for active TB, testing for latent TB infection among household contacts and provision of TB preventive treatment are now included in the national policies of all surveyed countries. Also, 81% of the surveyed countries, with more than 2.8 billion people, have policies in place that provide for a shorter TB preventive therapy regimen. Of concern is the finding that nearly half of the countries did not have policies on the provision of TB preventive treatment to household contacts of all age groups, even though they have committed to a specific UN target on this to be achieved by 2022.
"We as people affected by TB, believe that accountability must be strengthened and it must be a priority if we are committed to ending TB. The report, if followed up, will be a critical tool. We commit to using the findings and recommendations from the report alongside our own recommendations to help strengthen National TB Responses and change the experiences of millions of people affected so that we can end TB by 2030," said Maxime Lunga, a member of the Stop TB Partnership Affected Community Delegation in the Democratic Republic of Congo.
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According to Ditiu, Covid-19 has shown that the steps for procurement of drugs, diagnosis and treatment can be sped up if necessary.
"It is not only that you should have the right drugs recommended, but you also need to make sure that wherever you procure these drugs, they are quality assured. We have a large number of countries surveyed that are still not requesting the pre-qualification through WHO. It's great that local manufacturers are being used, but we need to assure that the drugs being taken are really of the right quality.
"The very important piece is this, we need to have the right policies in place. We have the right policies at international level in place - it needs to be taken up to country level. From here then we need to make sure that it is accessible to all the people in need and it's time in TB to work as well with the same speed as we see that it is possible with Covid-19 but we never applied to TB," said Ditiu.
