UN Seeks ‘Bold Action’ as WHO Sets 2030 Deadline for TB Eradication in Africa

• Nigeria will reduce TB burden gaps, Adewole assures citizens

Abimbola Akosile and Senator Iroegbu in Abuja

As the World Tuberculosis Day was marked on Saturday around the globe, the United Nations has revealed that the disease (TB) remains the top infectious killer worldwide as well as the leading cause of death among people living with HIV, claiming more than 4,500 lives daily.

The global body, in a release also called for bolder and concerted action to combat and end the TB scourge, as well as the dreaded Acquired Immunodeficiency Syndrome (AIDS) virus quickly.

According to the Executive Director of UNAIDS – the Joint UN Programme on HIV and AIDS – Michel Sidibé, “The world has the resources to end the interlinked epidemics of tuberculosis and HIV, but political commitment and country action are lacking.”

“Political, religious and civil society leaders need to step up to guarantee everyone the right to breathe, to live free from tuberculosis and AIDS,” he added.

For his part, Director-General of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, noted the “devastating” social and economic impacts of TB, including poverty, stigma and discrimination – adding that antibiotic resistance has caused many drugs to lose their efficacy in combating the disease.

“While the world has committed to end the TB epidemic by 2030, as part of the Sustainable Development Goals (SDGs), actions and investments do not match the political realty,” he stressed in a video message.

The UN is calling on all partners to take unprecedented and bold action to advance efforts to end TB and AIDS by 2030.

“Now is the time to make commitments become actions, we need increased and sustained financing,” Tedros spelt out, calling World Tuberculosis Day an opportunity “to mobilise political and social commitment for accelerated progress to end TB.”

While preventable and curable, persistent challenges remain, many of which are shared by the HIV response, including unequal access to services, the release noted.

Noting that both can be addressed effectively with integrated programmes, UNAIDS outlined five important actions for partners, beginning with impelling political, religious and civil society leaders to champion the universal right to live free from TB and HIV.

Secondly, communities must be empowered to call on governments to demand their right to health – improving living standards to reduce the burden of TB and HIV, it said.

The third action endorses promoting non-discriminatory service delivery to protect all against catastrophic health expenditures in the context of universal health coverage – extending care beyond health to include safe workplaces and places of detention.

Next, UNAIDS advocates that finance ministers be engaged to approach health as an investment, not an expenditure, in which returns demonstrate their long-term value to societies and economies.

Finally, the Joint UN Programme also recommends greater public-private sector partnerships to accelerate for innovative new medicines and vaccines.

In September 2018, world leaders will come together at UN Headquarters in New York for the first-ever UN General Assembly High-Level Meeting on Tuberculosis to adopt a progressive, visionary and actionable political declaration on the disease.

Both agency heads said the High-Level Meeting could provide the political, social and financial momentum needed to end TB.

“This year could be the most important since Robert Koch discovered the cause of TB, 136 years ago, but only if we all show leadership,” said Mr Sidibé. “I’m stepping forward for a TB-free world,” Mr. Tedros said, “please join me.”

In a related development, the World Health Organisation (WHO) has set 2030 deadline for eradication of tuberculosis (TB) in the African region.

The global body in the African Region and the African Union Commission are setting up ways to monitor progress towards ending the TB epidemic as called for in the Sustainable Development Goals.

WHO Regional Director for Africa, Dr. Matshidiso Moeti, who disclosed this in a statement to commemorate the World TB Day 2018 said he would strive continuously to support countries to accelerate actions for a TB-free world.

He said though the African Region has made good progress in controlling TB, the region still has the world’s highest levels of the disease, and only half of existing TB cases are being found by our health systems.

He added that Africa has the most patients infected with both HIV and TB, and are seeing alarming increases in the forms of TB that resist treatment with common medicines.

This, he said is due to the fact that governments are contributing only a quarter of the resources needed to provide adequate TB services, and 40 per cent of needs remain unfunded.

This year’s theme is “Wanted: Leaders for a TB-free world”. It seeks to build momentum towards the first UN General Assembly high-level meeting on TB in September this year, when Heads of State and governments and key players will resolve to end TB through urgent, global actions to achieve a TB-free world

Moeti said African leaders and government have a role to play in achieving the set goal and target for eradicating the disease in Africa.

“A TB-free world will only be achieved through leaders who champion efforts to end TB at local level. At the “First Ministerial Conference on Ending TB” in Moscow in November 2017, 75 ministers from the African Region committed to end TB. Member States of the African Union finalised a Common African Position on TB (CAP-TB) on the sidelines of that historic conference.

“Leaders have tremendous influence to build strong partnerships and commitment to end the TB epidemic at every level. I therefore call on governments, parliamentarians and policy-makers to drive ambitious plans that will accelerate TB control at national level.

“I strongly urge governments to scale up domestic funding for TB control and take responsibility for essential medicines and laboratory supplies. Furthermore, governments should push for universal coverage with proven high quality services. The implementation of these actions requires strong leadership. We want leaders for a TB-free world,” Moeti added.

He said since TB is found in communities where human rights and dignity are often overlooked, governments should lead actions beyond the health sector to address environmental, economic and other factors which increase the risk of TB.

He called upon health workers, non-governmental organisations and technicians to maximise the use of proven methods to diagnose and successfully treat all types of TB, and for researchers to do the scientific studies needed to inform policies to help improve and monitor TB services.

Moeti as well called on community leaders, patient advocacy groups and people affected by TB to partner government to ensure access to treatment for all.

As Nigeria joined the rest of the world to mark the 2018 World Tuberculosis Day, the minister of Health, Prof. Isaac Adewole has promised that the present administration will leave no stone unturned to reduce the TB burden gap.

According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and MDR-TB. The country is also ranked 7th among the 30 high TB burden countries and second in Africa. Nigeria is among the 10 countries that account for 64 per cent of the global gap in TB case finding. India, Indonesia and Nigeria account for almost half of the total gap.

During the ministerial briefing to commemorate the 2018 World TB day in Nigeria on Friday, Adewole said the major drawback in Nigeria’s TB programme is low TB case finding for both adult and children as there are a lot of missing TB cases that were either not diagnosed or diagnosed but not reported.

TB remains endemic in different parts of the world, leading to annual deaths of nearly one-and-a-half million people, mostly in developing countries. Over ten million new TB cases were estimated to have occurred globally in 2016.

“The TB burden is further compounded by the menace of drug resistance TB (DR-TB) and the HIV/AIDS pandemic. In 2017, the country notified only 109,904 out of the estimated 407,000 – all forms of TB cases (with treatment coverage of 25.8 per cent), leaving a gap of 302,096 comprising undetected or detected but not notified cases especially in non-DOTS sites. In the same year, the proportion of Childhood TB was 7 per cent of all forms of TB cases compared to 10 per cent recommended by the WHO.

“In addition, a total of 1783 DR-TB cases were notified out of the estimated 5200 DR-TB cases,”, he noted.

However, the minister said the TB/HIV collaborative activity is one of the key areas that Nigeria as a country is performing well in TB control activities.

According to him, “Currently 96 per cent TB and 82 per cent presumptive TB cases know their HIV status and 84 per cent co-infected clients receive ART and CPT.

“In our response to the burden of TB, the Federal Ministry of Health developed a robust National Strategic plan (NSP) for TB (2015 – 2020) as well as a framework to support the declaration of 2017 as a year of accelerating TB case finding and treatment in Nigeria.

“The implementation of the NSP for TB (2015 – 2020) though not without its limitations has brought noticeable improvements in TB control activities”.

He said this is because the current administration of President Muhammadu Buhari places high premium on health and TB is on its priority list and that TB consequently is a key component of the PHC under one roof project of the administration.

“We will strive to sustain the current achievements and scaled up priority interventions in order to ensure that we are on track with ending TB at a record time. Government will continue to provide quality assured anti-TB drugs for the treatment of patients with DR-TB.

“In addition to this, we will build the capacity of programme staff at all levels. Similarly, the introduction of new diagnostics and drugs will receive priority attention”, he promised.

To accelerate TB case finding, Adewole said the country has now moved from passive to active case-finding in key affected populations, including PLHIV, children, urban slum dwellers, prisoners, migrants, internally displaced people and facility-based health care workers, to target those most at risk for TB adding that over 11,500 TB cases were detected through active house to house case search in 2017.

He stated further that Nigeria currently has 6,753 DOTS centres compared to 3931 in 2010 and that the total number of microscopy centres has risen from 1,148 in 2010 to 2,650 in 2017.

“GeneXpert machines installed in the country have increased from 32 in 2012 to 390 in 2017. Treatment centres for patients with DR-TB have expanded from 10 in 2013 to 27 in 2017. The number of TB reference laboratories has also increased from 9 in 2013 to 10 in 2018. Over 90 per cent of the TB patients notified in 2016 have documented HIV test results compared to 79 per cent in 2010.

“In addition to this, shorter drug regimen for the treatment of DR-TB was introduced in Nigeria in 2017 to reduce the treatment duration for patients with DR-TB and ensure better treatment outcomes.

“All States have commenced treatment of eligible DRTB patients on shorter regimen treatment. I am delighted to inform you that the new paediatric anti-TB formulations for treatment of drug susceptible TB will be launched this afternoon.

“The formulations are both dispersible and flavoured and meet the WHO optimal dosing recommendations for all children. It is our hope that this new formulation will improve adherence and treatment outcomes”, he added.

The minister said the government has engaged key professional bodies like the Thoracic Society of Nigeria, Paediatric Association of Nigeria (PAN) and Nigerian Society for Paediatric Infectious Diseases (NISPID) as paediatricians are the ones piloting the affairs of the National Childhood TB Steering Committee (NCTSC).

In addition, he said the National Electronic TB Information Management System (NETIMS) was recently developed to improve real time reporting and monitoring of TB cases. All States actors have been trained and are reporting using this platform.

This apart, he said Private Sector engagement for TB is also being vigorously looked into as there is a robust Public-Private Mix (PPM) engagement plan for TB and that during the last National Council on Health (NCH) meeting in Abeokuta, Ogun state, a resolution was passed mandating all private health facilities in the country to compulsorily notify TB cases.

To further strengthen TB notification in some challenged states, he disclosed that TB Surveillance officers have been recruited in 12 states (Rivers, Delta, Imo, Anambra, Lagos, Oyo, Benue, Niger, Kaduna, Kano, Bauchi and Taraba) to work with non-NTP facilities (private Health facilities, Patent medicine vendors, community Pharmacist), disease surveillance and notification officers, state epidemiologist and state TB programme officers to improve TB case notification.

The minister reiterated that TB is curable, diagnosis and treatment of TB is free. People are encouraged to visit the nearest hospital for screening if they have cough lasting two weeks or more or current cough for people living with HIV (PLHIV).

Every 24th of March is set aside globally to commemorate the World TB day. It is a day designed to raise awareness on the disease. The celebration provides the opportunity as a country to reflect on progress made in the fight against TB.

The theme of this years’ world TB day is “Find and Notify all TB cases while the slogan is “Wanted: Leaders for a TB-free Nigeria.”

Meanwhile, Governor of Edo State, Mr Godwin Obaseki, has said the state government’s health architecture is primed on a well-equipped primary healthcare system that will help fight infectious diseases, especially with the intensification of immunisation efforts in the state.

The governor said this in commemoration of the World Tuberculosis Day, marked every March 24, by the WHO and other organs of the UN system to raise awareness of the disease.

The governor said the state’s investment in human capital cuts across the education and health infrastructure, noting that the building of 500 primary healthcare centres across the state will improve access to health care services.

On the theme for this year’s celebration, the governor said it is imperative for all leaders to mobilise their people to get immunised against tuberculosis, noting, “it is important to acknowledge the role of leaders in galvanising their people to get medical care at the centres closest to them.

“It is wrong for health workers to get to some communities and meet people who are not receptive to the drugs. We call on leaders to lead the campaign of educating their people on the need to get basic medical care rather than resort to self-help.”

The governor added that the state’s intent to set up a health insurance scheme is to make sure that health care services are accessible and affordable.

He added that the intensified campaign on immunisation in the state is anchored on the need for children to lead lives that are not shortened by vaccine-preventable diseases.

He said the speedy refurbishment of the Institute for Lassa Fever Research and Control, Irrua, which helped to stem the spread of the disease, shows government’s resolve to tackle health issues in the state.

He maintained that there is need to fund research, encourage collaborations and partnerships and improved commitment by civil society groups to raise awareness on the epidemic, especially in underserved communities.

According to the WHO, the celebration is “to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB) and to step up efforts to end the global TB epidemic. The event marks the day in 1882 when Dr. Robert Koch, announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosis and cure for the disease.”