Eradicating tuberculosis in hotspot regions

TB is a silent killer that can stay latent in the lungs, becoming active years later and infecting entire communities without warning. Carriers of latent TB are asymptomatic and cannot infect those around them. However, left undetected, latent TB can progress into the highly virulent, transmissible and often deadly active form of the disease. “It is very important that TB infection be recognized,” explains Dr. Aamir Khan,” executive director of IRD global, “because they are a at least a couple of billion people in the world who are infected with TB. And that pool of two billion or more individuals really is at very high risk of developing TB at any point in their life.”

A major problem is that tuberculosis detection rates are still low the world over, and the highly-affected populations often do not have access to diagnostic services. While curable in most cases, treatment is lengthy (6–9 months), costly, far away from a patient’s home, and frequently accompanied by debilitating side effects.

Pakistan – TB spares no one

The reason certain countries are so affected by this disease is mostly related to socio-economics, believes Dr. Jan, the head of the Aziz Medical Center in Islamabad, Pakistan: “Overcrowded schools and hospitals are a part of everyday life here. Such conditions provide a perfect environment for the spread of infectious diseases, especially TB. Anyone and everyone in Pakistan is exposed to TB, whether you attend school, step inside a hospital, or simply go shopping. TB spares no one – the disease affects all classes within the population.”

The risk is highest for children and migrant workers. One in four under the age of 15 in the country are estimated to have latent TB, compared to an estimated 15% of adults. High numbers of untested migrant workers originating in Pakistan, but working all over the world, are also responsible for unknowingly transmitting TB across borders, explains Dr. Jan.

“We use x-rays, PCR and QuantiFERON kits to test for latent TB,” he says of the clinic’s efforts to diagnose the disease. “QuantiFERON is a very reliable test and it needs just one visit to the clinic, a large benefit in rural areas, where people often have to travel a long way to the hospital.” Besides the distance, there’s another hurdle: money. “People are poor and the healthcare system runs on a deficit. Patients can rarely afford month-long therapy after testing positive. We lose these people because they believe in fast-acting but ineffective treatments, which only make things worse.”

Uzbekistan – TB treatment is a human right

Timur Abdullaev, a public health, law and human rights consultant living in Uzbekistan, is an engaged activist for “TBpeople.” This global organization connects people with TB with local activists from their network who know what to do, where to go, and who to get help from. Having first-hand experience, members of the group are very empathetic – they know what it is like to have TB, how the person may feel, and what they need. Abdullaev was himself diagnosed with the disease, not once, but twice, after suffering its symptoms for several months without being diagnosed.

“Each person has a right to know his or her TB status before receiving a potentially unnecessary medication. The problem is, with TB, a person immediately becomes a patient...But there is a difference between a human and a patient. We stigmatize patients, for instance, when they stop treatment. But the question we should be asking is why the person stopped their treatment. The answer is because the person didn’t know any better, or perhaps they weren’t given the information or attention they needed,” says Abdullaev. “A patient is not just a patient – they are human beings, and a human being needs to have support, without risk of being discriminated against for their illness,” he says with conviction.

Nigeria – Ensuring better access

In Nigeria, TB is the leading cause of infectious disease deaths, affecting mainly younger individuals aged 15 to 44. As this is notably the most economically productive age group in the country, the burden is significant. Elom Emeka, deputy director of medical laboratory services and head of the TB laboratory unit within the Federal Ministry of Health, coordinates Nigeria’s implementation of the national strategic plan (NSP) for TB control. The NSP focuses on better identification of at-risk populations like individuals who are HIV-positive and young children to rule out active TB cases, test for latent TB, and then provide and ensure complete treatment.

The problem he says, like in other highly-affected countries, is that TB detection rates are still quite low in Nigeria. The success of any initiative is highly dependent on effective deployment of treatment and early disease diagnosis. “In some regions of the world, health authorities are adopting a blanket treatment strategy for anyone considered to be at high TB risk, without first testing for infection. This approach risks exposing patients to unnecessary treatments with unpleasant side effects, and increases the chances of breeding multidrug-resistant bacterial strains,” says Emeka.

The rollout of effective testing regimes helps to ensure that only those patients who really need treatment receive it, and allows resources to be deployed efficiently. Nigeria’s Ministry of Health has just approved the adoption and implementation of QuantiFERON-TB Gold Plus as a modern alternative to the often unreliable tuberculin skin test. “This [QuantiFERON-TB Gold Plus] controlled laboratory test requires only one patient visit, is highly specific and sensitive, and a positive result is strongly predictive of a true infection by M. tuberculosis, whether it is latent infection or active disease,” says Emeka. The key to one day eradicating this silent killer is finding reliable ways to detect latent TB.