Comment

Comment by bobby ramakant on January 6, 2010 at 2:06pm

Dear friends,
Greetings on the new year 2010! This year 2010, is declared as the Year of the Lung (more information here).

It will be great learning from you all how appropriate are lung diseases like asthma, pneumonia, tuberculosis, smoke-related illnesses and others in your communities?

be hearing from you all,

warm wishes, bobby

Comment by bobby ramakant on December 14, 2009 at 6:10am

Dear TB Competence members,
WHO has released an update to the Global Tuberculosis Control Report 2009. One of the most shocking findings in the new data from WHO is that hardly more than 1% of people with MDR-TB (multi-drug resistant TB) get standard treatment (6000 out of 500,000 MDR-TB patients get treated as per standards).

Earlier WHO had reported that about 3% of MDR-TB patients get treated - this time, the numbers are gory - clearly stating that close to 99% MDR-TB patients go untreated as per standards.

This can fuel further drug resistance - and I shudder to think of morbidity and mortality which goes unreported.

The reality as per WHO is that drug resistant TB is an outcome of poor programme performance of DOTS - we need to fix treatment of 'simple' or drug susceptible TB - and make sure we diagnose EARLY and treat successfully....

It will be good to hear frontline experiences from you all,
warm wishes, bobby
-------------------------------

36 million people with TB cured

Up to 8 million lives saved through 15 years of DOTS programmes, but millions still unable to access high quality care

Some 36 million people have been cured of tuberculosis (TB) over the past 15 years through a rigorous approach to treatment endorsed by WHO. New data, released by WHO, also indicate that up to 8 million TB deaths have been averted, confirming DOTS/the Stop TB Strategy as the most cost-effective approach in the fight against tuberculosis.

(To download/ read the Global Tuberculosis Control Report 2009 Update, click here)

DOTS was first developed in 1994 and was later incorporated into the WHO Stop TB Strategy as its main component. DOTS has five elements: political commitment with increased and sustained financing, case detection through quality-assured bacteriology, standardized treatment with supervision and patient support, an effective drug supply and management system, monitoring and evaluation system and impact measurement.

Steady progress in curing TB and saving lives
Since the launch of DOTS, the number of people being cured has increased regularly. Data from the latest 12 month period now shows that the highest ever number of infectious patients – 2.3 million people – were cured. With 87% of treated patients being cured, the 85% global target was exceeded for the first time since it was established in 1991. Furthermore, a total of 53 countries surpassed this treatment milestone.

The WHO update shows continued progress on addressing the lethal combination of TB and HIV. Between 2007 and 2008, 1.4 million TB patients were tested for HIV, an increase of 200, 000. Of those who tested HIV positive, one-third benefited from life-saving HIV anti-retroviral therapy (ART) and two-thirds were enrolled on co-trimoxazole prophylaxis to prevent the risk of fatal bacterial infections. In addition, screening for tuberculosis and access to isoniazid preventive therapy for TB among people living with HIV more than doubled, although the total number is still far short of what it should be.

"Fifteen years of TB investments are bringing visible results in terms of human lives saved. Together, national programmes, WHO, UNAIDS, the Global Fund and other partners have helped save millions of lives from TB," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "But the current pace of progress is far from sufficient to decisively target our goal of TB elimination."

Not all receiving the treatment they could
Although more and more patients are being cured, there are millions who are being let down because they are unable to access high-quality care. TB remains second only to HIV/AIDS in terms of the number of people it kills. In 2008, 1.8 million people died from TB including half a million deaths associated with HIV - many of them because they were not enrolled on ART.

A persistent challenge that is being largely left unchecked in many parts of the world is multidrug-resistant TB (MDR-TB) and its even more dangerous form, extensively drug-resistant TB (XDR-TB). Of the estimated half a million MDR-TB cases occurring per year, almost 30 000 were officially reported and 6 000 were known to be treated according to WHO international standards in 2008. A major expansion of services is currently in an early and difficult phase but almost 29 000 people are expected to be treated in 2010.

Of the estimated 9.4 million TB cases in 2008 (including 1.4 million TB/HIV cases), 3.6 million cases occurred among women.

"Half a million women died from TB last year. It is a disease that destroys lives, damages families and stifles development," said Dr Mario Raviglione. "Without help to fill the US$ 2 billion funding gap for TB care and control in 2010, the most vulnerable people will continue to miss the benefits so many others have seen."

The new report provides the most accurate information on the global burden of tuberculosis. It also features updates about the work of the Global Laboratory Initiative, the WHO Global Task Force on TB Impact Measurement, and describes the success of a new initiative in 2009 in which global TB data collection went online.

Comment by bobby ramakant on December 13, 2009 at 6:22pm

Thanks Rituu for sharing the news. I was speaking to an expert from Tuberculosis Research Centre, Indian Council of Medical Research (ICMR) - Dr M Muniyandi - and he said:
"Unless TB patients are diagnosed earlier, the quality of life will be compromised despite of successful anti-TB treatment"

"To attain better quality of life, it is important to diagnose people earlier for TB and treat them successfuly" emphasized Dr Muniyandi.

TB even if successfully treated, leaves the body parts (lungs in case of pulmonary TB) affected that may adversely impact quality of life.

So there are two points of advocacy in this regard: 1) diagnose TB, and diagnose EARLY and of course complete full anti-TB treatment as per WHO standards.

Thanks Dr Muniyandi for speaking up - the point you make is right on-spot: quality of life. This should be an explicit and core aim of TB programmes to EARLY diagnose and treat people with TB successfully so that they can enjoy highest attainable standards of health and life. And in passive case finding, it is a distant dream. Engaging communities can up the active case finding among many other benefits TB conference is raising (and has been raising in past years).

The absence of the Patients' Charter for Tuberculosis Care (PCTC) in the local stop TB strategy operationally is often the very barrier that blocks access to existing TB care services. Long waiting hours, stigma and discrimination related to TB, lack of confidentiality at times, unfriendly healthcare services for people with certain conditions, are well documented barriers that impede access to existing services. Other obstacles that limit the impact of TB programmes which are now coming to light over past years, were the realities people with TB were dealing with. Long distances they have to travel to clinics, economic impact on their livelihood during anti-TB treatment which may further exacerbate vulnerabilities to TB and other conditions of them and their families/ communities, are just some of them. Communities knew it before, and knew it best. Empowering them will not only bring problems in light sooner, but also give them a right and responsibility as equal partner to come up with effective solutions that work in their own contexts.

Comment by Rituu B. Nanda on December 13, 2009 at 6:09pm

Dear All,

I came across this disturbing news item which notes that delay in TB testing is a major cause of death among PLHIV. The report examines the main factors leading to the delay.

Rituu

Delay in TB testing leading cause of HIV+ deaths
My News - November 27, 2009
http://www.mynews.in/News/Delay_in_TB_testing_leading_cause_of_HIV+...

New Delhi: Even though half of the 2.4 million people living with
HIV/AIDS in India contract Tuberculosis making it the leading
cause of death, less than five per cent of them get automatically
tested for TB, a study has revealed.

A multi-centre study conducted by INP+, a national network of
people living with HIV/AIDS, with support from ACTION (Action
to Control TB Internationally) Project revealed significant
delays in both detecting and treating TB especially in people
living with HIV/AIDS (PLWHA) in India.

About 70 per cent respondents got TB treatment initiation after
a delay of four weeks while 80.3 per cent got the treatment
after a delay of two weeks.

According to the study, both patient end and provider end cause
for the delays in getting appropriate TB diagnosis and treatment
initiated. Lack of awareness and knowledge about TB ranks high
among the patients and was the major cause fordelay in seeking
appropriate diagnosis and treatment services.

Distance to the nearest TB service delivery point is a key barrier
from the provider end, with average travel times exceeding 90
minutes for over half of the population surveyed, the study at
the multi-centre operational study in Manipur on barrier in
accessing and adhering to TB treatments especially with a focus
on people living with HIV/AIDS.

Nearly a third of the survey population reported paying for their
medication, indicating an incomplete reach and awareness of the
free national TB control programme (RNTCP).

''People living with HIV/AIDS are among the most vulnerable to
getting TB infections. Any delay in this vulnerable population
getting life saving TB treatment is also indicative of the broad
systemic issues of accessibility that need to be addressed quickly.

The delay in getting appropriate diagnosis for HIV co-infected
individuals also reflects on the failure to get newer diagnostic
tests on to the market and in our healthcare delivery points,''
said Dr Venkatesan Chanrapani, the lead researcher of the the study.

Comment by Laurence Gilliot on November 30, 2009 at 5:53am

Hi Bobby and friends,

I'm interested to learn more about how communities, families and individuals deal with TB by themselves. How do they help themselves? How do they support one another? How do they stimulate inclusion of TB patients?

We believe in people's strengths. Services and medication are really important but they don't solve the problem by themselves. So, how do people use their strengths to stop the spread of TB locally?

In the longer term, it would be very interesting to have a close look at the communities that are really successful. Based on their key practices, we could then together develop a self-assessment on TB.

Cheers,

Laurence

Comment by bobby ramakant on November 26, 2009 at 9:26am

Thanks Bijaya for your comment and raising a key issue that certainly needs more attention - TB and people with disabilities (PWD).

I am glad to see your offer to broadcast stories on this issue through your network using PC broadcasting, community radio and video among others. This is really valuable to disseminate the documentation on TB and PWD related issue as widely as possible to bring in the change.

This is a real learning Bijaya and we at TB Competence are here for sharing and mutual learning. I learnt about a perspective (TB and people with disabilities) I didn't know about enough. Big thanks for helping me understand this issue related to PWD.

Bijaya, I was wondering if it is possible for you to share more experiences related to TB and how people with disabilities (PWD) access TB prevention, diagnosis, treatment and care services and help us understand more?

be hearing from your end

Comment by Bijaya Satapathy on November 26, 2009 at 8:52am

Hi,

I am from India.TB with any additional decease like HIV/Aid or Disability is a serious concern.I meet with some TB patient and person with disability PWD that awareness is very much lacking.The present day need is to build awareness,education,infrastructure and so on for TB-Disability-HIV/Aids.

We are interested to broadcast this cause to the world community.Using ICT live stories, real time voice conference, audio,Text,Pic etc., can be piloted for NGO community worldwide.Any person or organization interested to fight for this cause will be provided consultancy,training and technology free of cost.

Please feel free to contact for PC-Broadcasting,Community Radio,IP-Video any where anytime pilot project around the world.

This is a good initiative by Bobby.

Bijaya

Comment by Gaston on November 26, 2009 at 5:46am

Dear Bobby,

Thank you for this initiative. To be honest, I am not that involved in this link so far, so I am happy to hear experiences and sharing on this. The TB news already gives some good background.

Can you share some of your wide experience on this link between HIV and TB. Thanks.

Comment by bobby ramakant on November 25, 2009 at 12:37pm

Dear friends,
Welcome to the TB Competence group! TB Competence group provides a platform to connect and share our experiences with local responses to TB and TB-HIV co-infection, and related issues.

Your experiences, perspectives and opinions on dealing with TB on daily basis are invaluable, and needs to be documented, to inform the TB, TB-HIV co-infection, and other related responses on the frontlines.

You are most welcome to speak-your-world

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