Why tuberculosis still kills if it is curable and preventable – 12/11/2023 – Health

At Kaneshie Polyclinic, a health center in a poor neighborhood of Accra, the capital of Ghana (West Africa), there is a rule. Every patient who walks through the door – a woman in labor, an injured construction worker, a child with malaria – is given a tuberculosis test.

This nationwide policy aims to address a tragic problem: two thirds of the population of this country have tuberculosis and do not know it.

The disease, which is preventable and curable, regained its title as the leading cause of death from infectious diseases in the world, after being overtaken in its long reign by Covid-19. But around the world, 40% of people living with the so-called “TB” are untreated and undiagnosed, according to the WHO (World Health Organization). The disease killed 1.6 million people in 2021.

The numbers are even more worrying because this is a time of great hope in the fight against tuberculosis: significant innovations in diagnosis and treatment have begun to reach developing countries, and clinical trials of a new vaccine have given promising results. Infectious disease experts who have been fighting tuberculosis for decades express a new conviction that, with enough funding and commitment to bring these tools to neglected communities, the disease could be nearly defeated.

“This is the best news we’ve seen about tuberculosis in decades,” says Puneet Dewan, a public health researcher in the tuberculosis program at the Bill & Melinda Gates Foundation. “But there’s a gap between having an interesting project and actually reaching people with these tools.”

A recent visit to the Kaneshie clinic revealed the progress made and also the obstacles that remain. Despite the clinic’s policy of testing for tuberculosis, which most often attacks the lungs, in all cases, with a few questions about coughing and other symptoms, patients entered the single-story, cement-block building and were sent for care without any questions asked. . It turned out that one team member was on vacation, another was on maternity leave and a third was sick. There were only two left, busy processing tests and distributing medicines.

Therefore, no one was tracked, neither on that day nor on any other day in the previous week.

“It’s a good policy, it works well when we can do it, but staffing is a problem,” says Haphsheitu Yahaya, the clinic’s tuberculosis coordinator.

When the screening policy works, new medicines – the first to hit the market since the 1970s – can be taken in a few pills a day, rather than handfuls of pills and painful injections, as treatments were administered in the past.

People with a drug-resistant diagnosis receive medicine for six months – a much shorter time than previously needed. For decades, the standard treatment for drug-resistant tuberculosis was to ingest substances daily for a year and a half, sometimes two years.

Inevitably, many patients stopped treatment before being cured and ended up with more serious illnesses. The new medications have far fewer undesirable side effects than the old ones, which could cause permanent deafness and psychiatric disorders. These improvements help more people stick to their medications, which is good for patients and relieves pressure on a fragile healthcare system.

In Ghana and most other countries with a high prevalence of the disease, the medicines are funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international partnership that raises money to help countries combat these diseases. But contributions to the agency have declined with each round of funding.

Countries fighting TB are worried about what might happen if the funding ends. Currently, treatment for adults recommended by the WHO costs at least US$150 per patient in low- and middle-income countries.

Only 169 health centers in Ghana have the capacity to use the new testing method. Typically, samples must be transported, which can take up to 3 hours by car in some rural areas. When the results come back, it can be difficult to locate the people who were tested.

“The equation is simple: if we invested more resources in TB testing, we would find more TB,” says Yaw Adusi-Poku, director of Ghana’s national disease control program.

This will require more molecular testing sites, more staff trained to detect the disease, more people to ask questions at the clinic door, more nurses like the intrepid Boadi, who shows up at patients’ doors to encourage them to get their families tested ( and often digs into his own pocket to help patients pay for bus fare to pick up their medication).

Molecular diagnosis is considerably more expensive than the old method. Cepheid, the company that makes cartridges for the testing machines, recently agreed to reduce the price of each of them from $10 to $8. An analysis commissioned by Doctors Without Borders concluded that the cartridges could be manufactured for less than $ $5. Cepheid continues to charge $15 per test to diagnose the extremely drug-resistant disease, the most lethal form.

Funding for tuberculosis services in low- and middle-income countries has fallen to US$5.8 billion in 2022 from US$6.4 billion in 2018, which is just half of what the WHO says is needed. About $1 billion is available each year for research, half the amount the UN says is needed.

At a special UN meeting on the disease in September, governments pledged to spend at least US$22 billion a year until 2027. But at a similar meeting in 2018, the same donors pledged to spend US$13 billion until 2022, of which less than half materialized.

“I’m happy that we have these innovations, but the fact that they exist and the WHO recommends them doesn’t mean that people have access to them,” says Madhukar Pai, associate director of the International Tuberculosis Center at McGill University in Montreal (Canada). . “The costs are still very high, and someone needs to provide them.”