As the COVID-19 pandemic threatens to derail the global response to tuberculosis (TB), Médecins Sans Frontières/Doctors Without Borders (MSF) has called on governments to accelerate testing, treatment, and prevention for TB, and for donors to provide financial support to ensure increased access to new medical tools for diagnosing and treating millions with this disease.
Experts said that India is still following a very conservative approach regarding the new medicines for drug resistant TB, putting lives of patients including children in danger. Scaling up of new DR-TB drugs — Bedaquiline and Delamanid — is needed even more during Covid-19.
Amid pandemic, need to maintain TB services continuity
While reporting on the severe impact of the Covid-19 pandemic on TB services, WHO revealed a sharp drop in the number of people diagnosed. Besides needing to catch up to maintain continuity of existing TB services, it advised countries to adopt better testing policies and practices. Countries still fall short on rolling out up-to-date testing policies that can assist in reaching nearly 3 million people being missed.
Until March 2020, India had 1,19,960 MDR-TB patients who were eligible for Bedaquiline. However, only 10,845 had received it. Hence, 1,09,115 patients were not given this medicine, even as India is home to a quarter of the world’s DR-TB patients, according to sources.
A report released on Monday by MSF and the StopTB Partnership — Step Up for TB — surveys 37 high TB-burden countries and shows that critical medical innovations are reaching far fewer people who urgently need them, because many countries continue to lag in getting their policies in line with new World Health Organization (WHO) guidelines. MSF officials said Covid-19 has worsened their plight.
TB remains the world’s top infectious disease killer, with more than 10 million people falling ill and 1.4 million people dying due to this disease in 2019.
National treatment programmes must prioritise use of all-oral treatment regimens for people with drug-resistant TB (DR-TB) that no longer include older, toxic drugs that have to be injected and cause serious side effects.
The report finds that only 22% of countries surveyed allow TB treatment to be started and followed up at a primary healthcare facility, instead of travelling to a hospital, for instance, and for medicines to be taken at home. Additionally, 39% do not use a modified all-oral shorter treatment regimen and 28% of countries surveyed still are using injectable medicines when treating children with DR-TB.
“Instead of stepping up for TB, we are at risk of slipping back due to COVID-19,” said S Lynch, Senior TB Policy Advisor for MSF’s Access Campaign. “We cannot stress enough how urgent it is now for governments and donors to intensify their efforts so That critical medical innovations and tools reach people with TB. We finally have better drugs and tests to tackle and prevent this extremely infectious yet curable disease, so it’s both mind-boggling and unacceptable that they’re still not being used to save as many lives as possible.”
As highlighted in the report, 85% of countries surveyed do not use the lifesaving point-of-care urinary TB LAM test for routine diagnosis of TB in people living with HIV, as recommended by WHO.
“As clinicians working on the frontlines of the TB epidemic, it is distressing to see the sluggish uptake of TB LAM (urine lipoarabinomannan assay) in national treatment programmes, despite its proven role in saving lives of people living with HIV,” said Dr Patrick Mangochi, Deputy Medical Coordinator for MSF in Malawi.
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