Reducing TB cases

It is well known that TB is one of the world’s top health challenges, with an estimated 10 million new cases in 2017 and 1.3 million deaths. Over 95 per cent of TB deaths occur in low and middle-income countries, poor communities, and vulnerable groups.
According to the World Health Organisation (WHO), while there has been significant progress in the fight against TB, with more than 54 million lives saved between 2000 and 2017, the battle is only half-won, as some 4000 people lose their lives each day to this leading infectious disease.
At a recent international forum, which was organised to help complement the functioning of, and assist in capacity building among national TB laboratories, Minister within the Public Health Ministry, Dr Karen Cummings, boasted that Guyana is currently winning the war against tuberculosis (TB). She said that in spite of the Human Immunodeficiency Virus (HIV) causing a spike in the number of TB cases dealt with, the National Tuberculosis Control Programme (NTP) and the National AIDS Programme Secretariat (NAPS) were working round-the-clock to heighten the Isoniazid Preventative Therapy in citizens living with the deadly disease.
Even though Guyana still has a far way to go, this country can boast of tremendous progress made in its fight against TB, and all efforts must be made to ensure these gains are not reversed. It could be recalled that the actual number of new TB cases diagnosed by the National TB Programme (NTBP) rose steadily throughout the 90s. However, with some key interventions by the previous Administration; such as the implementation of the Directly Observed Treatment Short (DOTS) programme (2002-2007), annual cases declined from 2008, and stabilised for four years thereafter due to further DOTS expansion.
Based on official statistics, the case notification rate over the past five years decreased from 92 per 100,000 in 2012 to 70 per 100,000 in 2017. This is quite an achievement, and kudos must be given to all the stakeholders who are working to further reduce TB cases in Guyana.
Some years ago, the DOTS System was successfully implemented in all the regions of the country, and it has been essential to ensuring case detection and standardised treatment, with supervision and patient support. That said, the national rate is still below the target for WHO END TB Strategy 2025 of 90 per cent.
According to analysis by the WHO of the TB epidemic, “momentum is growing at country and community levels – including in the 30 countries with the highest TB burden (over 85 per cent of the global burden). A number of countries are strengthening the strategic agendas of their TB programmes, by adopting newer tools, extending access to care, and linking with other parts of Government to reduce the financial costs borne by patients. Other countries are partnering with researchers to speed development of diagnostic tests, drugs and vaccines, and to improve delivery”.
However, despite these advances, formidable challenges remain, including fragile health systems, human resource and financial constraints, and the serious co-epidemics with HIV, diabetes, and tobacco use.
Ending TB will only be achieved with greater collaboration within and across Governments; and with partners from civil society, communities, researchers, the Private Sector and development agencies. This means taking a whole-of-society and multidisciplinary approach in the context of universal health coverage.
Funding also remains a crucial component. All partners can help take forward innovative approaches to ensure that everyone suffering from the disease has access to TB diagnosis, treatment and cure.
Governments and NGOs may have the best ideas to tackle TB, but it makes very little sense if there are inadequate financial resources to ensure their effective implementation.
The authorities here must continue to build on the gains made over the years regarding efforts to reduce TB cases in keeping with the WHO targets.