October 20, 2017
Now the leading infectious disease killer, tuberculosis (TB) is in the global spotlight as world health leaders prepare for next year’s UN High-Level Meeting to tackle the disease. Global health experts and advocates met in Guadalajara, Mexico, last week at the Union World Conference on Lung Health. There, they discussed the urgent efforts needed to reach the goals set forth in the Global Plan to End TB 2016-2020, including:
- Reaching 90 percent of people affected by TB
- Reaching 90 percent of key populations
- Achieving 90 percent TB treatment success
The first 90-(90)-90 progress report of the Global Plan to End TB outlines how much progress has been made in meeting these goals, and how much work is left to be done, such as scaling up TB prevention and care services while making sure no one is left behind.
Unfortunately, none of the countries with a high disease burden have achieved 90 percent treatment coverage for TB. Eighty percent of people with drug-resistant TB remain undiagnosed, and 90 percent of people are not being treated successfully. This is particularly concerning as the world is combatting the deadly, dangerous and growing threat of drug resistance.
For the second goal, TB data on key populations needs to expand and a standardized approach must be achieved. As the progress report notes, data for national TB programs worldwide are currently only collected routinely for one key population: people living with HIV. Lastly, the first-line TB treatment success rate globally is 83 percent, which represents a decline for the past two years. Only eight countries with a high TB burden have reached the goal of 90 percent treatment success.
The news for second-line treatment is even more a cause for concern. The second-line treatment success rate is only 50 percent, and none of the countries with a high drug-resistant TB burden have achieved the 90 percent treatment success goal.
This TB news may be bleak, but there have been recent developments in innovative technologies to help diagnose TB more easily and quickly, help monitor patients’ regimens to ensure treatment adherence, and help prevent drug-resistance.
According to Devex, the first innovation is a shift from direct supervision of patients taking medicines – which requires extensive oversight by medical professionals and community health workers – to Wirelessly Observed Therapy (WOT). WOT involves an ingestion sensor, an external wearable patch and a mobile device that allow health workers to remotely monitor and confirm that TB pills were taken. This could translate to major reductions in the cost of ensuring each patient sticks to treatment, helping to prevent the spread of drug resistance.
Other innovations aim to make TB diagnosis more efficient. Currently, diagnosis requires a patient to cough up sputum, which is then analyzed for TB. However, researchers have found that oral swabs might be used instead to diagnose TB, and with more accuracy. While diagnostic equipment like a GeneXpert machine would still be necessary, this innovation could make sample collection easier, quicker and safer, as well as help countries with high TB burden to find “missing” cases of the disease. Finally, new results suggest that a quick blood test might also be able to replace sputum collection in the diagnosis of active TB, with results in about 15 minutes. The blood test wouldn’t require power or special training, and could be used virtually anywhere.
Innovations such as these to diagnose TB cases more quickly and effectively will be key to achieving the 90-(90)-90 goals, ending this deadly epidemic within a generation, and allowing people around the world to live their lives in good health.