Fighting the stigma. The key to eliminating TB.

It took Dr. Rosa Herrera eight years before she could openly admit that she had once been ill with tuberculosis. Such was the stigma surrounding the disease in her home city of Mexicali, on the US-Mexico border, that even an educated medical professional was made to feel shame for something utterly beyond her control. For having been infected while healing other people.

Herrera, now a mother of two young children aged four and six, was 25 years old when she contracted TB, while working as an intern in a local hospital. Following an earthquake, all the hospital's patients had to be evacuated and re-located to the Emergency Room. This sudden overcrowding proved a fertile environment for spreading the illness, and Dr. Herrera was one of its victims. "So during this time, I realized what it is like to be a sick person," she says, "and what the challenges are that we have to face."

Over the following months she ignored her symptoms, attributing her shortness of breath and fatigue "to the long hours that I was working on the ER when I didn't have much time to rest or to eat properly." When she could no longer walk more than two or three metres, it took one of her patients - a woman in labor - to point out that she clearly was not okay. Finally, she admitted to herself that there was a problem, and a chest x-ray revealed a pleural effusion across her right lung.

The diagnosis was "a shock". Not only that, but active TB, one that presents as symptomatic, is often contagious.

Lack of empathy and diagnosis tools

Herrera’s full recovery took almost a year, involving surgery and complications due to adverse reactions to some of her treatments, and what she calls "a huge lack of diagnosis tools". Worse, though, was the reaction of some colleagues and family members. "I suffered in many ways from the stigma," she says, "even from my own colleagues around the hospital. They were asking me to wear a mask even when I was not contagious."

Herrera's family also didn't understand how the disease works, and avoided her completely. "That caused so much pain for me," she stresses, "it was so lonely…not to be with all my family. Only my mother took care of me. I was isolated and alone in my room for a month, it was really difficult."

Herrera learnt much from her time in recovery, and was now determined to devote her career to fighting tuberculosis. She altered her course of study to focus on TB, and says that although she "suffered through hard times" as a patient, "they taught me a lot about the importance of being empathetic, and how that support gives the patient the opportunity to get the cure, or finish their treatment. And it showed me first-hand how people are not really well educated about the disease."

Knowing that even friends and family can react so severely when they find out you have TB is one of the challenges in encouraging patients to get tested.

It's time to talk about TB

"There's not only this stigma when it comes to talking about the disease," she says, "but also to talking about the stigma itself, or the situations you have to face. In the past I felt ashamed because I had tuberculosis and it took me around eight years to say openly that I had had TB, and that I had recovered." The way forward, Herrera believes, is to talk about the disease. To explain that there is no shame in getting tested and treated, since treating latent TB is simple. Much simpler than dealing with the risk of getting sick and infecting others.

Herrera now works with the Zero TB Initiative's mobile unit to reach those communities that not only need educating about TB, but testing and treatment for it too. One of largest groups vulnerable to TB in Mexicali are drug abusers and the homeless population, who have the highest incidence of both active and latent forms of tuberculosis. "And when you have this disease together with having a drug problem, it's really hard to look after yourself. You are only going to receive health care when you are severely ill. So that means they have been contagious for a long period of time before they get treatment,” says Herrera.

Quicker tests mean quicker treatment

QIAGEN is currently developing a new test that is specifically designed for high-TB-burden countries like Mexico that do not always have access to complex testing labs.

The QIAreach QuantiFERON-TB Test not only will deliver similar accuracy to other TB blood testing methods, but it will also be much more accessible. "It is portable, you don't need to invest a lot of money to make this possible," she says. "So we can envision making these tests available in communities where the resources are pretty low."

The test will also eliminate the need for a second visit. "We can diagnose the infection and we don't have to go back - we can take action immediately, because the test result is ready in 20 minutes. We don't need a lot of staff or to invest in extra resources, and we don't need cold storage, which is a big point in a place like Mexicali - it can get up to 50 degrees in the summer."

A single visit is particularly important in a place like Mexicali because, Herrera explains, "we have lost the follow-up on several patients who for various reasons can't show up for a second visit." Also, with a TST test "it is really hard to ensure we are going to come back 72 hours after the first application. If the staff are not well trained, you won't be sure the correct duration between visits is properly observed." QIAreach, though, "will be easy. You only need one visit, one tube and one millilitre of blood, and you will have accurate results in 20 minutes.

We can eliminate TB

At present, medical staff on the tuberculosis frontline need all the help they can get. Dr. Herrera believes that the international response to the corona virus is evidence that, when humanity puts its mind to a problem, it can find a long-term cure. After all, for COVID-19 it came up with multiple vaccines in just one year.

"We already know that TB is a highly preventable and one hundred per cent curable disease. It is so important that the survivors share their experience so other survivors raise their hands and say, 'I have it too, and you can survive through this and we can be supportive of each other.”

“It is so clear that we need to put our resources together as we have done with COVID-19, and maybe if we do something with that amount of effort, we could really eliminate tuberculosis... We will change history and we will save so many millions of lives."