Keeping Up the Momentum to Control TB

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World TB Day 2016 comes at a watershed time in the history of the tuberculosis (TB) epidemic and the broader global response to health and development. In recent years, we have expanded access to more sensitive TB diagnostic services, increased awareness about the important role of infection control within health care settings and have new treatment options for individuals with multidrug-resistant (MDR) TB. But, there is much work still to be done.

TB now rivals HIV as the top global infectious disease, yet we have not applied the same vigor to controlling TB as we have to controlling the HIV epidemic. That time is no longer. We have the opportunity to mirror the advances gained toward ending the HIV epidemic, largely based on evidence, driven by ambitious targets and linked to well-designed guidance.

In many parts of the world, HIV poses a particular challenge to TB control, which we cannot ignore. We have developed HIV prevention and treatment tools that will allow us to end the HIV epidemic, and we must add urgency to align these with TB control efforts. Doing so will assure successful outcomes in the fight against HIV and TB coinfection. The urgency comes from World Health Organization reporting that indicates mortality from TB eclipses mortality from HIV. The tremendous research and program advances from unprecedented investments in the HIV response must be leveraged to take control of TB morbidity and mortality.

This moment in time is particularly important as we transition to the Sustainable Development Goals (SDGs) that will guide policy and funding over the next 15 years and are linked to a pledge to end poverty, everywhere, permanently. While health is now only one of 17 goals, the shift in focus may bode well for control of TB, which is a disease of poverty exacerbated by malnutrition, overcrowding and poor hygiene.

FHI 360's TB initiatives strategically align with the SDGs. Our projects provide technical assistance to governments to yield evidence-based solutions to their local TB situations. We assist governments with improved disease surveillance so they can invest in ways that will yield the greatest impact by providing curative treatment and limiting new infections. We promote an approach that focuses on those most vulnerable in society because TB concentrates in the most marginalized populations of any given society. A human rights-based approach that engages affected communities is the basis for a sound, effective response.

TB treatment programs are grappling with how to scale up new tools: rapid, more sensitive diagnostic tests; shorter, effective prevention strategies; and a modestly expanded portfolio of treatment options for drug-resistant TB. To be successful, efforts in each high-burden country will require increased investments and locally driven solutions. Integrated programs that combine multiple health programs, rather than disease-specific programs, with links to education and social and economic development efforts, are all welcome approaches to detecting, treating and preventing TB.

The broader goals of the SDG era, which focus on ending poverty, hunger and inequality, will contribute to reducing TB transmission and controlling TB. The specific goal of good health and well-being will support a decline in TB incidence and accelerate elimination.

The time is now to continue to make smart investments in TB and HIV control. This concerted effort will strengthen health systems and go a long way to address the basic needs of people living throughout the world.