November 4, 2016

Exploring the Recent Progress and Challenges of Tackling Tuberculosis

In the previous post in this blog, I discussed a report published in 2014 by The Economist Intelligence Unit (EIU) that investigates the health challenge posed by tuberculosis (TB) and ways to improve the effectiveness of the global response to it. On Oct. 26, 2016, The EIU announced the publication of an updated report, which evaluates "the progress made in the global response to TB since The EIU’s 2014 study." The 2016 report, Tackling tuberculosis: Recent progress and challenges, first considers "the socioeconomic and political context of tackling TB and then look at policy and progress in the areas of prevention, diagnosis and treatment. Moreover, four country case studies shed light on recent progress and challenges in tackling TB in Ethiopia, Kenya, Nigeria and South Africa."

On the chapter titled "The Political and Socioeconomic Context," the report explains that "the prospects for improving TB prevention, diagnosis and treatment efforts are intrinsically linked to socioeconomic and political factors. For a start, a country's level of development has a strong influence on its response to the disease."

According to Michael Kimerling, director of the technical services division at the Netherlands-based KNCV Tuberculosis Foundation, which works to strengthen health systems in the fight against TB, "As you build up primary health infrastructures, the stronger these become, the better TB can be managed. It's such a classic disease of public health. Development is important for overcoming TB."

A stronger political will to tackle TB is necessary as "the disease continues to receive relatively less attention than other higher-profile diseases, the experts interviewed for this report say." Mario Raviglione, director of the Global TB Program at the WHO, is quoted as saying, "Fundamentally, what needs to be recognized is a lack of political commitment. As we mentioned in [the UK medical journal] The Lancet a few years ago, TB is not a main priority among any of the main UN agencies; it does not have a special UN program, is not in UNICEF's portfolio and is not a special presidential initiative in the US. It does not have strong support from the pharmaceutical industry."

On the topic of policy and progress on prevention, diagnosis and treatment, the report notes the World Health Organization's goal of reducing TB by 90 percent by 2030 "will require new tools that are currently lacking . . . including better prophylaxis, the development of vaccines and new treatment regimens, especially for MDR TB."

With respect to improving diagnostics and prevention, the report asserts that "reliably identifying vulnerable populations that are most likely to go on to develop TB would allow for a more rapid management of the disease and avoid exposing those at lower risk to treatment regimes that involve significant side effects, Dr Raviglione says. He adds that current tests only show whether a person has been exposed, but not whether they are likely to develop full-blown TB. Around one-third of the world's population has latent TB—where they have been infected with mycobacterium tuberculosis but have not developed the active disease —according to the WHO."

The report's conclusion notes: "Two years on from our original report there is evidence of some progress on the global response to TB, including, for example, efforts to shorten treatment regimens. At the same time, however, public-health experts observe that TB retains a relatively low disease profile in terms of R&D, both compared with diseases such as HIV/AIDS and in proportion to the impact of the disease. Major political and socioeconomic challenges remain, notably the lack of universal access to health coverage in many endemic countries, insufficient political will and deficient national TB control plans."

And I agree with the report's final paragraph: "Ultimately, progress will depend on the political will to underpin greater investment in research and the willingness of more countries to commit to both national policy frameworks and cross border partnerships."

Lastly, given the interest of colleagues and I have regarding the development of mobile software solutions to prevent infectious diseases such as TB, I would be reminiscent not to mention how the EIU's 2014 report or 2016 update addresses this topic. Below is an excerpt from the 2014 report:
The Kenyan Ministry of Health, along with Safaricom, one of the country's major mobile-phone companies, and a number of other partners have developed a data management system called TIBU, which means 'cure' in Swahili. Since November 2012, this has allowed the direct entry of details on new TB infections, using tablet computers at the point of diagnosis, into a national database that currently holds details on around 90,000 patients. The information can then be used in a wide variety of ways. At the national level, it enables the monitoring of trends, as well as indicating if any districts are performing poorly and need support. Local clinicians can use it to determine in real time if drug stocks are able to meet local need and to order new medication where required. It allows the treatment of individual patients to be followed even if they migrate to a different part of the country, and sends SMS messages to anyone who does not attend a clinic, reminding them to take prescribed their pills. Finally, TIBU is linked with Kenya’s mobile payments system, M-Pesa, to allow faster dispersal of support payments to those with MDR TB who continue to adhere to treatment.
Do you agree with the findings of the report? What is your recommendation on achieving WHO's goal of reducing the incidence of TB by 90 percent by 2030? What role should mobile technology play in achieving this goal?

Aaron Rose is an advisor to talented entrepreneurs and co-founder of great companies. He also serves as the editor of Solutions for a Sustainable World.

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