Let Us Unite for Zero TB Deaths. A QnA blog with Dr. Caroline Tatua

Dr. Caroline Tatua

Global initiatives such as the WHO’s “Global Plan to End TB 2023-2030” and the Stop TB Partnership offer structured frameworks aimed at coordinating action and mobilizing resources to expedite progress towards eliminating tuberculosis (TB). In observance of World TB Day, our East Africa Communication manager engaged in a discussion with Dr. Caroline Tatua, Health Technical Advisor at the International Rescue Committee and a 2022 East Africa Alumni, delving into the critical topic of ending TB.

Efforts to fight TB were hampered by the COVID-19 pandemic, what progress post covid have you observed in the global fight against TB, and what are the key challenges that still need to be addressed?

Before the COVID-19 pandemic, tuberculosis (TB) control efforts were gaining momentum, with a notable decline in TB incidence rates and mortality globally. The World Health Organization (WHO) set ambitious targets to end the TB epidemic by 2030, aiming for a 90% reduction in TB deaths and an 80% decrease in TB incidence compared to 2015 levels. However, the pandemic disrupted essential TB services, leading to missed diagnoses and treatment interruptions. Fear of contracting COVID-19 deterred people from seeking healthcare services, further exacerbating the TB burden.

As countries began to recover from the immediate impacts of the COVID-19 pandemic, efforts to revitalize TB control programs gained momentum. Governments, international organizations, and civil society stakeholders renewed their commitments to address TB and mitigate the pandemic’s disruptions. Efforts were made to strengthen healthcare systems and ensure the continuity of TB services, including innovative approaches such as telemedicine, community-based care, and mobile health clinics. Investments in research and development continued to advance TB diagnostics, drugs, and vaccines, with a renewed focus on addressing drug-resistant TB. According to the 2023, World Tuberculosis report, there was a huge recovery in the number of people diagnosed and treated for TB thanks to the surge testing and treatment that followed the COVID pandemic.

Global initiatives, such as the WHO’s “Global Plan to end TB 2023-2030” and the Stop TB Partnership, provided frameworks for coordinated action and resource mobilization to accelerate progress towards TB elimination goals. There have been Advocacy efforts aimed to raise awareness about the intersection of TB and COVID-19 and mobilize political support for sustained investment in TB control.

While the post COVID period offered opportunities to reinvigorate TB control efforts, significant challenges have remained and continue to hamper efforts including funding gaps including / aid diversion, strained and weak healthcare systems, disparities in healthcare access, interrupted TB services and drugs and commodities supply, increased disease transmission, drug-resistant strains, and challenges in reaching vulnerable populations.

How can communities, particularly women and girls, be effectively engaged in TB prevention and control initiatives, and what role do they play in driving progress?

Effectively engaging communities, particularly women and girls, in TB prevention and control initiatives requires tailored approaches addressing their unique needs and circumstances. There are several ways in which communities and women and girls can be engaged.

  1. Education and Awareness: Women and girls often hold influential roles within their families and communities. By providing education and raising awareness about TB prevention, symptoms, and treatment, they can disseminate critical information, promote early detection, and encourage seeking timely healthcare.
  2. Advocacy and Empowerment: Empowering women and girls to advocate for their own health and the health of their communities can lead to increased TB case detection and treatment adherence. Through community mobilization and participation in decision-making processes, women and girls can drive demand for TB services and resources.
  3. TB Screening and Referral: Women and girls can be trained as community health workers or volunteers to conduct TB screenings, identify individuals with symptoms, and refer them to healthcare facilities for further evaluation and treatment. Their familiarity and trust within the community can facilitate access to TB services, especially in hard-to-reach areas.
  4. Addressing Social Determinants: Women and girls are disproportionately affected by social determinants of health such as poverty, gender inequality, and lack of access to education and healthcare. TB prevention and control initiatives must address these underlying factors to effectively reach and engage women and girls in TB care.
  5. Integration with Maternal and Child Health Services: Integrating TB services with maternal and child health programs can enhance access to TB screening, prevention, and treatment for women and children. Providing TB services alongside routine maternal and child health visits can help identify TB cases early and prevent transmission within families.
  6. Research and Data Collection: Women and girls can contribute to TB research and data collection efforts by participating in studies, sharing their experiences, and providing valuable insights into gender-specific challenges and barriers to TB prevention and control.

Women and girls play a critical role in driving progress towards ending TB.  As caregivers, they often serve as primary healthcare decision-makers within families, influencing health-seeking behaviors and treatment adherence. Their roles in community health promotion and education can significantly impact TB awareness and prevention efforts. Moreover, women and girls are key contributors to the healthcare workforce, comprising a significant portion of frontline healthcare workers and community health volunteers. Their involvement in TB care delivery, advocacy, and research is essential for designing gender-responsive interventions and addressing the unique needs of women and girls affected by TB.

Empowering women and girls with education, resources, and leadership opportunities not only enhances their own health outcomes but also contributes to broader efforts to eliminate TB by leveraging their influence and expertise within families, communities, and healthcare systems.

Overall, effectively engaging women and girls in TB prevention and control initiatives requires recognizing their unique roles, addressing gender-specific barriers, empowering them as advocates and community leaders, and integrating TB services with existing healthcare and social programs. By involving women and girls as key stakeholders, progress towards ending TB can be accelerated and sustained.

What innovations or research initiatives are you excited about in the field of TB control, and how do they have the potential to impact TB outcomes, especially for women?

I am particularly excited about innovations and research initiatives in the field of TB control

New TB Diagnostics: Advances in diagnostic technologies have led to the development of rapid and more accurate TB diagnostic tools. For example, molecular diagnostic tests like the Xpert MTB/RIF assay have revolutionized TB diagnosis by providing quicker and more sensitive detection of TB and rifampicin resistance directly from sputum samples. These innovations improve early detection, enabling prompt initiation of treatment and reducing transmission as well as improve patient outcomes.

 Shorter Treatment Regimens: Research has focused on developing shorter and more effective treatment regimens for TB, particularly for drug-sensitive and drug-resistant cases. The STREAM trial, for example, evaluated a nine-month regimen for multidrug-resistant TB, demonstrating non-inferiority to the conventional 20–24month regimen.  Shorter regimens are definitely welcome to TB patients as they improve treatment adherence and outcomes, reducing the burden of TB on patients and healthcare systems.

New TB Treatments: Bedaquiline and Delamanid are two new drugs approved for the treatment of multidrug-resistant TB (MDR-TB) which had posed a critical challenge in TB control. Additionally, research into repurposing existing drugs and investigating new drug candidates, such as nitroimidazoles and oxazolidinones, holds promise for expanding treatment options and combating drug-resistant TB.[1]

TB Vaccine Development: Efforts to develop an effective TB vaccine continue, with several candidates in various stages of their clinical trials[2]. IAVI which is in the forefront of TB vaccine development, has partnered with various pharmaceutical companies including Biofabri in the advanced clinical development of the MTBVAC vaccine and with Moderna in evaluating a series of mRNA vaccines. Advancements in vaccine development offer hope for reducing TB incidence and controlling the spread of the disease[3]

These innovations and research initiatives demonstrate ongoing progress in TB control efforts, with the potential to improve diagnosis, treatment, and prevention strategies for TB globally. This is particularly for for women and girls.

Rapid and accurate diagnostic tools like the Xpert MTB/RIF assay can enable earlier detection of TB, reducing delays in diagnosis and facilitating timely initiation of treatment. This is especially beneficial for women and girls who who may face may face barriers such as limited access to healthcare facilities or stigma associated with TB, allowing them to receive prompt care and support.

 Shorter treatment regimens for TB, as demonstrated in trials like the STREAM trial, offer several advantages for women and girls including reducing the duration and complexity of treatment, making it easier for them to adhere to the prescribed regimen. Shorter treatment courses also minimize the risk of treatment interruptions, which can lead to treatment failure or the development of drug resistance. Additionally, reduced treatment duration can alleviate the burden of TB on women’s caregiving responsibilities and daily activities.

The development of an effective TB vaccine, holds promise for preventing TB infection and disease, including among women and girls. Vaccination can provide long-term protection against TB, reducing the risk of transmission within communities and households. By preventing TB disease, vaccination can also help mitigate the social and economic impacts of TB on women and girls, including loss of productivity, stigma, and discrimination.

Overall, these innovations in TB control have the potential to improve TB outcomes for women and girls by addressing barriers to diagnosis, treatment, and prevention. By ensuring equitable access to innovative tools and interventions, tailored to the specific needs and circumstances of women and girls, we can make significant strides towards reducing the burden of TB and achieving better health outcomes for all.

How important is international cooperation and collaboration in addressing the global TB burden, and what are some successful examples of cross-border partnerships in TB control?

International cooperation and collaboration are essential in addressing the global TB burden due to the transnational nature of the disease and its impact on public health, economies, and social well-being. Several examples come to mind to highlight the significance of international collaboration in TB control

Global Fund to Fight AIDS, Tuberculosis and Malaria[4]: The Global Fund plays a crucial role in financing TB control efforts worldwide. It supports countries in implementing TB prevention, diagnosis, and treatment programs, particularly in low- and middle-income countries where the burden of TB is highest. By mobilizing resources from governments, private sector partners, and donors, the Global Fund strengthens health systems and promotes innovation in TB control.

Stop TB Partnership[5]: The Stop TB Partnership is a collaborative platform that brings together governments, civil society organizations, researchers, and donors to accelerate progress towards ending TB. It facilitates knowledge sharing, advocacy, and resource mobilization for TB control initiatives globally. Through partnerships with diverse stakeholders, the Stop TB Partnership promotes innovation, fosters political commitment, and supports countries in implementing evidence-based TB interventions.

World Health Organization (WHO)[6]: As the leading global health authority, WHO plays a central role in setting norms, standards, and guidelines for TB prevention, diagnosis, and treatment. It provides technical assistance to countries, coordinates global TB surveillance and reporting mechanisms, and promotes research and innovation in TB control. Through its Global TB Programme, WHO collaborates with member states, partner organizations, and stakeholders to strengthen health systems and accelerate progress towards ending TB.

Research Consortia and Partnerships: International research consortia and partnerships, such as the Tuberculosis Trials Consortium (TBTC) and the TB Alliance, facilitate collaboration among scientists, clinicians, and public health experts across different countries and regions to develop new TB diagnostics, treatments, and vaccines. By pooling expertise and resources, these collaborations accelerate the translation of research findings into tangible interventions for TB control.[7]

A number of cross border partnerships have demonstrated the effectiveness of collaborative efforts in addressing the global TB burden. A few notables are as below

  1. European TB Research Initiative (ERI-TB): ERI-TB is a consortium of European Union (EU) member states and associated countries that aims to coordinate TB research efforts across borders. By pooling expertise, resources, and infrastructure, ERI-TB fosters collaboration among researchers, clinicians, and public health experts to advance TB diagnostics, treatment, and prevention strategies. The initiative promotes joint research projects, capacity building activities, and knowledge sharing to accelerate progress towards ending TB in Europe.
  2. East African Community (EAC) Tuberculosis and HIV/AIDS Control Program: The EAC Tuberculosis and HIV/AIDS Control Program is a regional initiative that brings together six East African countries—Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda—to address the dual epidemics of TB and HIV/AIDS. Through cross-border collaboration, the program strengthens TB and HIV/AIDS surveillance, diagnosis, treatment, and prevention services, particularly among mobile and migrant populations. By sharing best practices, leveraging resources, and harmonizing policies and strategies, the EAC countries work together to reduce the burden of TB and HIV/AIDS in the region
  3. Mekong Basin Disease Surveillance (MBDS): MBDS is a network of six countries in the Mekong Basin region—Cambodia, China (Yunnan and Guangxi provinces), Laos, Myanmar, Thailand, and Vietnam—that collaborate on infectious disease surveillance and control, including TB. Through cross-border information sharing, joint training programs, and coordinated response mechanisms, MBDS enhances early detection and response to TB outbreaks and promotes the implementation of evidence-based TB control strategies across borders. The network strengthens regional capacity to address TB and other infectious diseases that pose a threat to public health and economic development.
  4. Central America Regional TB Program (PARCA): PARCA is a regional initiative that aims to strengthen TB control efforts in Central America by promoting collaboration among eight countries—Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic. Through PARCA, countries coordinate TB surveillance, diagnosis, treatment, and prevention activities, particularly among marginalized populations living in border areas. The program supports cross-border initiatives such as mobile TB clinics, joint training workshops, and information sharing mechanisms to improve TB control and reduce transmission in the region.

Through these examples, we can underscore the critical role of international cooperation and collaboration in addressing the global TB burden. By working together across borders and sectors, countries can leverage collective expertise, resources, and political commitment to accelerate progress towards achieving the targets outlined in the WHO End TB Strategy and operational plan 2023-2030 and ultimately ending the TB epidemic.

Finally, on this World TB Day, what message or call to action would you like to convey to policymakers, healthcare providers, and the public in accelerating progress towards ending TB?

The one call to action to effectively eradicate TB on World TB Day is to “Unite for Zero TB Deaths.” This call emphasizes the urgent need for global solidarity, collaboration, and commitment to ending TB-related deaths. It encourages policymakers, healthcare providers, communities, and individuals worldwide to come together, prioritize TB control efforts, allocate resources, and implement evidence-based interventions to prevent TB deaths. By rallying behind this call to action, we can accelerate progress towards achieving the ambitious goal of zero TB deaths and ultimately ending the TB epidemic for good.

[1]Reference: Tiberi S, du Plessis N, Walzl G, et al. Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies. The Lancet Infectious Diseases. 2018;18(7):e183-e198.)

[2] https://www.iavi.org/iavi-pipeline/

[3] Nemes E, Geldenhuys H, Rozot V, et al. Prevention of M. tuberculosis Infection with H4:IC31 Vaccine or BCG Revaccination. New England Journal of Medicine. 2018;379(2):138-149.)

[4] The Global Fund. “Tuberculosis.” https://www.theglobalfund.org/en/tuberculosis/

[5] Stop TB Partnership. “About Us.” https://stoptb.org/about/)

[6] World Health Organization. “Tuberculosis.” https://www.who.int/health-topics/tuberculosis#tab=tab_1

[7]Tuberculosis Trials Consortium. “About Us.” https://www.tbtc.org/about-us; TB Alliance. “About Us.” https://www.tballiance.org/about-us