The third edition `Out of Step’ report published today by the international medical humanitarian organisation Médecins Sans Frontières (MSF) and the Stop TB has highlighted the need for governments to increase efforts to combat tuberculosis (TB).
Two days ahead of the G20 summit in Germany, the report that reviewed TB policies and practices in 29 countries – which account for 82% of the global TB burden – said that that countries can do much more to prevent, diagnose and treat people affected by TB.
Although TB is preventable and treatable, it remains the world deadliest infectious disease. In 2015 alone, 1.8 million people died from it. In 2015, the majority (54%) of the 10.4 million people with TB lived in the countries represented at the G20 summit. Despite its deadly toll, most countries lag behind in implementing the new tools that are available to tackle TB.
India has the world’s highest TB burden; in 2015, 2.8 million people fell ill with TB and 480,000 people died from it. However the diagnostic gap remains massive. Only seven countries in the report have made Xpert MTB/RIF – a rapid molecular test to diagnose TB and test for resistance to first-line TB drugs – widely available. This means that the majority of people in the 29 countries surveyed are still tested with a method that fails to detect many cases, or that requires a wait of up to several months to confirm the disease. This challenge explains why so many people remain undiagnosed and untreated; globally in 2015, based on the gap between estimated TB incidence and the actual number of cases reported, 4.3 million people with TB were never diagnosed.
India has not taken up this challenge and this molecular test is not the initial TB diagnostic test for adults and children being investigated for TB here, the Out of Step report has said. Smear microscopy is often used as the initial diagnostic test in the private sector, where up to 70% of people are treated – and delays in diagnosis and treatment initiation are common. Access to Xpert MTB/RIF is limited to India’s reference or tertiary hospitals, which increases the risk of loss to follow-up before a confirmed diagnosis.Another test TB -LAM – a rapid point of care urine test -used to diagnose TB in persons living with HIV who are seriously ill is not widely available.
A 2015 review of India’s National Strategic Plan (NSP) reported that many key performance indicators had not een achieved, and that uptake of Xpert MTB/RIF was slow. The review recommended costing, fully funding and implementing universal DST by 2019 (and by 2015 in settings with a high burden of MDR-TB). Currently, there are more than 735 Xpert MTB/RIF machines in the country NSP 2017-2025. By 2019, the country’s Central TB Division plans to deploy 1,019 GeneXpert machines and a network of at least 120 labs for DST, with the goal of treating at least 60,000 people with MDR-TB each year.
“TB is an ancient killer, but we have the knowledge and the tools to tackle this disease; many countries are just not making use of these advances, and people are dying as a result,” said Lucica Ditiu, Executive Director of The Stop TB Partnership. “We’re calling on the G20 leaders to wake up and do something to stop the unnecessary deaths and the spread of TB, including drug-resistant TB.”
“With TB, the clock is ticking rapidly, as every 18 seconds a person dies of TB. We have to change that,” said Sharonann Lynch, HIV and TB Policy Advisor at MSF’s Access Campaign. “The number of people diagnosed over the last four years has stalled, while the number of deaths has increased rather than decreased. Countries need to use new tools and step up the pace of their response,” Lynch said.