Finding all TB is the key to stopping the spread of the infectious disease, and to do that, experts call upon governments to take diagnostic facilities to the people instead of bringing them to the lab.
The call came from a multi-stakeholders meeting in the Indian tourist state of Goa on Friday, where experts from around the world and journalists from India, Nepal, and Bangladesh endorsed a global call of action to end TB as it continues to kill 1.5 million people worldwide every year, despite being a preventable and curable disease.
Early and accurate diagnosis is the key to TB care, with the WHO asking countries to use molecular testing methods instead of old microscopes for better diagnosis. It is also a public and human rights imperative, as it helps stop the spread of the TB infection as well as reduce unnecessary human suffering and deaths.
Examples of “laboratory on wheels” in many parts of the world, including Bangladesh, also came up in the meeting as a way to show how the lab can be taken to the people.
“We need to change our mindset,” Dr Tara Singh Bam, Board Director of the Asia Pacific Cities Alliance for Health and Development, Singapore, said. “Ensure community-based universal screening with no targets—find all and treat all.”
TB People (India), Asia Pacific Cities Alliance for Health and Development (APCAT), People’s Health Organization (PHO), Asia Pacific Media Alliance for Health and Development (APCAT Media), Journalists Against Tuberculosis (JATB), and online portal CNS jointly organized the meeting with the theme “Find TB to Stop TB”.
TB is caused by Mycobacterium tuberculosis, and it most often affects the lungs. So, it spreads through the air when people with lung TB cough, sneeze, or spit. A person needs to inhale only a few germs to become infected, according to the WHO.
Most of the people who fall ill with TB live in low- and middle-income countries, but TB is present all over the world. About half of all people with TB can be found in eight countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, the Philippines, and South Africa.
With its national TB program, Bangladesh has improved the TB control scenario and saved approximately 2.3 million lives from 2012-2021.
The government figures show deaths from TB have reduced from 45 deaths per 100,000 in 2015 to 25 in 2021. Additionally, drug-resistant TB services have been decentralized.
Still, Bangladesh remains a high-TB burden country, with one person being infected with the disease every minute. In 2021, about 375,000 individuals were infected with TB, of whom 42,000 died.
The government is expanding its program to detect missing cases. For that, it is using the “laboratory on wheels” approach, in which a portable machine accredited by the WHO is taken to hard-to-reach areas such as Chittagong Hill Tracts in a car.
The global call endorsed in Goa said that bringing “lab to the people” and “not people to the lab” is the first vital step towards finding TB.
“If we fail to do this, we will keep missing TB cases despite having the best tools in the labs,” read the statement.
“Additionally, we must ensure that the full cascade of TB care services is people-centered,” it said.
The call to find all TB to stop TB, has 1 key ask and 2 actions. The ‘key ask' is “Stop missing TB cases”.
Key actions include 100% replacement of smear microscopy with WHO-recommended molecular tests as soon as possible, along with a paradigm shift from a lab-centric to a fundamentally people-centric model to find TB, leaving no one behind.
And the second is to find the missing millions by screening everyone, not just those with TB symptoms, with WHO-recommended screening tools and confirming those with presumptive TB using molecular tests.
“If we act upon the key 'ask', imagine the difference it will make when no TB case is missed and all people with TB are brought into the care fold in a rights-based manner. A people-centric approach to finding all TB, treating all TB, and preventing TB is critical to ending TB,” according to the global call.
The Indian state of Goa has already replaced microscopy with 100 percent molecular testing, including point-of-care and decentralized molecular testing, well ahead of the WHO’s target to do it by 2027.
Vietnam examples also came up in the meeting as the Southeast Asian country screened everyone and could drop the TB rates by 72 percent in four years.
"Building the whole of the government and the whole of the societal approach for TB elimination is needed with local leadership, local actions, and one health approach,” Dr Singh said.
He said instead of focusing on donors, countries can generate domestic resources to fight TB by imposing higher taxes on harmful products such as tobacco, alcohol, sugary, and sweetened beverages.
“I think there's something that we need to really look at in our own minds. We need to change ourselves first. I think it's time to really think about how to engage the people,” he said.
“For example, in tobacco control, we always talk about the rights of the smokers and the rights of the non-smokers—exactly the same thing in TB. Of course, we have to talk about the rights of people with TB. At the same time, we have to talk about the rights of the people without TB because there is something there—the exposure there in a community.
“So now we need to really empower the people and build the rights of the people with TB and without TB. Then we can only find all TB,” Dr Singh added.
