Untreated, unrecorded patients threaten fight against TB


A  growing trend of drug-resistance in the tuberculosis (TB) disease is threatening the gains in global TB control. Also compounding the TB problem, are an estimated three million patients missing out on care from health systems.

 This revelation was contained in the World Health Organisation (WHO) Global Tuberculosis Report 2013, in which it was observed that TB programmes do not have the capacity to find and care for people who are hard-to-reach, often because they are outside the formal or state health systems.

retroviral-drugs “Quality TB care for millions globally has driven down TB-related deaths, but far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown. The problem is not only that the links in the multi-drug-resistant tuberculosis (MDR-TB) chain are weak, but that these links are simply not there yet. The WHO estimates that 75 percent of the three million missed cases are in 12 countries.

 “Many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.  The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis.

“ It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care.  We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB,” the report stated.

 Beyond this, another challenge identified in the report relates to the TB and HIV co-epidemic. While there has been significant progress in the last decade in scaling-up antiretroviral treatment for TB patients living with HIV, less than 60 percent were receiving antiretroviral drugs in 2012. This, the report urges, must improve.

 Speaking with BusinessDay, Osahon Enabulele, National President, Nigerian Medical Association (NMA), said that non-availability of second-line drug susceptibility testing centres, which are quite crucial in management of MDR-TB with high rate of tuberculosis in HIV infected persons, up to 26 percent, has led to a drawback to TB eradication in the country.

 While funding of TB control activities is another area of poor performance, with only 71 percent budget implementation, only 28 percent came from domestic sources and 48 percent from Global Fund, an international funding partner of the US Government, an observation considered as ominous, Enabulele said.

 “The 2013 budget estimates show that whereas there is a marginal increase of 2 percent in domestic funding, contribution from the Global Fund has depreciated to 42 percent, a sign for Nigeria to start looking inwards for other funding options for the fight against TB.