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Ending TB 2020

TB tests exist, but remote communities are hard to reach

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Lucica Ditiu

Executive Director, STOP TB Partnership

Tuberculosis (TB) remains the world’s leading infectious killer. Ending the TB epidemic by 2030 is one of the health targets of the UN’s Sustainable Development Goals.

The world’s renewed commitment to TB prevention requires a dramatic expansion of care: ensuring access to TB testing and treatment for 30 million people over the next three years, including four million children, six million people living with HIV and 20 million household contacts of TB.

“Expanding access to testing for latent TB will play a critical role in reaching the ambitious UN targets of putting at least 30 million people on TB preventative treatment by 2022, especially among household contacts of people with TB,” says Lucica Ditiu, Executive Director of the Stop TB Partnership.

A global commitment to expanded TB testing and treatment

In 2018, the 30 high TB burden countries accounted for 87% of new TB cases. Eight countries account for two thirds of the total, with India leading the count, followed by, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

To address the gap in testing and treatment in these high-burden countries, world leaders at the UNHLM agreed to:

  • treat 40 million people for TB disease in the five-year period 2018–2022;
  • reach at least 30 million people with TB preventive treatment for a latent TB infection in the five-year period 2018–2022;
  • mobilise at least US$13 billion annually for universal access to TB diagnosis, treatment and care by 2022; and
  • mobilise at least US$2 billion annually for TB research.[1]

Critical diagnostic tests are available

There are treatments available that can eliminate latent TB before it becomes infectious. These include the more common TB skin tests, and the less-commonly-used but often more successful, Interferon Gamma Release Assay (IGRA) tests. However, accessing and accurately diagnosing those people who would benefit from this treatment is very difficult, especially in poorer communities (see pictured above).

Even after a patient has been identified and successfully diagnosed, if they are given the commonly-used TB skin test, they then have to visit clinics multiple times to get their results. And, false positives are common, particularly if an individual has had the BCG vaccination.

IGRA testing involves a blood test that can provide an accurate result for a patient during the first visit. This ensures treatment can be started swiftly and avoids the need for multiple visits, which may be a burden on those who are already time poor, meaning appointments may be missed.

The World Health Organization recognises the vital role that IGRAs play and has endorsed IGRA testing in their guidelines as a critical component of the fight to eradicate TB.

IGRA testing now available through the Stop TB Global Drug Facility

So why aren’t IGRA tests the default treatment option? Mostly, because of the price tag. Stop TB Partnership’s GDF facility hopes to overcome this, to improve treatment for all. “GDF ensuresaccess and helps match demand for TB diagnostics and drugs with funding from donors, governments and non-governmental organisations,” says Ditiu.

The Global Drug Facility (GDF) for tuberculosis (TB) was launched on World TB Day 2001 as a new approach towards ensuring universal access to, and efficient national systems of procurement and distribution of, anti-TB drugs.

GDF is the largest provider to the public sector of quality-assured tuberculosis medicines, diagnostics and laboratory supplies. Operating a unique pooled procurement system, the GDF facilitates access and helps match demand for TB diagnostics and drugs with funding from donors, governments and non-governmental organisations.

GDF has recently added an IGRA (interferon-gamma release assay) for latent TB infection to its diagnostics catalogue. By making the IGRA tests both accessible and affordable, GDF aims to level the playing field and ensure that public sector and not for profit organisations operating in low- and middle-income countries can use the very best diagnostic tools and treatment.

[1] UNHLM A/RES/73/3

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