Working to close the TB diagnostics and treatment gap

Tuberculosis and TB-MDR detection and treatment program in Lima, Peru. How can development practitioners collaborate to modernize and scale up TB diagnosis and care? Photo by: Pan American Health Organization / CC BY-ND

In its latest Global Tuberculosis Report, the World Health Organization estimates that effective diagnosis and treatment have saved 43 million lives between 2000 and 2014. That’s nearly a 50 percent drop in mortality. These powerful statistics not only remind us that TB is both preventable and curable, but they show just how much transformation we can bring about when we pair global ambition with action.

So how can it be that TB remains one of the world’s biggest health threats, ranking as the number one cause of death from infectious disease worldwide?

First, efforts to eliminate TB are being thwarted by the alarming spread of multidrug-resistant TB — now considered a global public health crisis. Secondly — and quite cruelly — it is the poorest areas of the world that typically bear the brunt of the burden.

Although new MDR-TB drug treatment options have brought hope for patients, many live in resource-scarce and remote areas where it is difficult to access adequate diagnostic tools. Not only does this delay or prevent treatment of very sick people, but these patients continue to fuel the ongoing spread of infection at the rate of up to 10 people per year. Given the availability of treatment options, it is unacceptable that only one in four cases of MDR-TB is detected and only one in two successfully treated.

This is why we need to see a deep commitment to tackle critical global health challenges. For example, Janssen — a pharmaceutical company of Johnson & Johnson — and FIND recently announced a formal partnership to step up the fight against TB, and especially MDR-TB.

A key focus will be to identify and work with partners to accelerate the development of highly portable and affordable point-of-care molecular diagnostic tools for TB and drug resistance that can generate results within hours. Molecular tests that detect resistance in hours have now been developed and used successfully even in low-resource settings. Their adoption has already helped drive an increase in the number of TB patients being tested for drug resistance but still, only 12 percent of new TB cases were tested for resistance in 2014.

New diagnostics are indeed only a part of the solution. Effective implementation along with efficient referral systems demand innovative solutions and multistakeholder collaboration. For example, training is needed to ensure proficiency in conducting tests, evaluating results and monitoring treatment for patients with MDR-TB.

All health care providers and laboratories in the public-private mix must be linked to ensure national guidelines are followed and patients diagnosed with TB or MDR-TB are notified to the National TB Program and receive the right care.

These are major challenges and certainly within our partnership we will work with NTPs and other partners to explore strategies for implementing diagnostic solutions and for quickly linking patients to the right care and treatment.

5 ways global health practitioners can help to have an impact:

• Modernize and scale up laboratory capacity with prompt access to rapid diagnostics that can detect MDR-TB

• Implement training and quality control throughout the diagnostic process

• Strengthen links between health care providers in the public-private mix

• Ensure national guidelines are followed and implement referral systems to appropriate treatment and care

• Collaborate and innovate

There are models of success that we can look to. South Africa has been particularly effective at rolling out the Xpert MTB/RIF diagnostic test and speeding up links to treatment. In one township on the fringes of Cape Town, for example, over a period of six years a combination of quicker testing and decentralization of MDR-TB care has led to the time from diagnosis to treatment for drug resistant TB dropping from 73 days to just seven.

It is essential that global health initiatives and practitioners — those with expertise in diagnosis and treatment — collaborate and deliver a truly sustainable and scalable impact among underserved populations battling TB and MDR-TB.

We fully embrace the post-2015 TB agenda, which has a new ambition to reduce TB deaths by 95 percent by 2035 and cut new cases by 90 percent. To achieve these ambitious goals it is imperative that global health and development practitioners collaborate to modernize and scale up TB diagnosis and care, to deliver a continuum of access from prevention to cure.

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About the authors

  • Parys wim

    Wim Parys

    Wim Parys is the head of research and development at Janssen's global public health group. He was development head of Janssen’s infectious diseases and vaccines therapeutic area and he led the discovery and development of other medicines for HIV, hepatitis C, multidrug-resistant tuberculosis and respiratory viral diseases. He held several R&D positions and developed a drug for Alzheimer’s disease and three innovative HIV drugs. He obtained his medical degree from the Katholieke Universiteit Leuven, Belgium.
  • Claudia denkinger

    Claudia Denkinger

    Dr. Claudia Denkinger is the head of tuberculosis and hepatitis program at FIND. She completed her medical school training and doctoral thesis in immunology at the Julius-Maximilians University in Wuerzburg, Germany. She trained in internal medicine at the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston and also was the chief medical resident there. She has worked in nongovernmental organizations in HIV and tuberculosis care in South Africa and South America. She holds a faculty appointment in the division of infectious disease at the BIDMC, Harvard Medical School.