As the World Health Organization (WHO) convenes a ‘call to action' this week on the need to scale up access to preventive treatment for tuberculosis (TB), Doctors Without Borders (or Médecins Sans Frontières, MSF), has urged all governments to support and ramp up the implementation of TB preventive treatment (TPT).
TB is the second biggest infectious disease killer after COVID-19, and the medical humanitarian organisation has also demanded that pharmaceutical and diagnostics corporations make affordable and accessible, to all in need, all drugs and tests needed to implement TPT.
A statement released by MSF said that COVID-19 only recently surpassed TB as the world’s number one infectious disease killer. In 2019, TB claimed 1.4 million lives, and more than 10 million people fell ill. While treating people who are currently sick with TB is essential, another critical measure to control and reverse the tide of the global TB burden is to promptly identify those at risk and prevent them from developing the disease through preventive treatment or TPT.
TPT involves providing anti-TB drugs to family and other close contacts of people sick with TB, to people with HIV or other conditions that weaken their immune system, or to people otherwise at-risk, including prisoners. This preventive treatment will prevent people with latent TB (someone infected with TB but not yet sick, contagious or showing symptoms) from developing full-blown TB. Scale-up of TPT is even more critical in the context of COVID-19.
In 2018, at the United Nations High-Level Meeting on TB, it was agreed countries would attempt to meet the target of 30 million people started on TPT by the end of 2022. However, even though the effectiveness of TPT has been repeatedly demonstrated, progress is lagging. With only 18 months left, governments must urgently prioritise the implementation of preventive TB treatment.
“It’s unacceptable that millions of lives continue to be taken by TB when preventive measures exist,” said Dr Gabriella Ferlazzo, senior TB/HIV advisor at MSF’s Southern Africa Medical Unit. “Governments must urgently step up and fulfil their commitments and invest in TB preventive action so that everyone in need, including children and particularly vulnerable populations like people with HIV, people who are incarcerated or refugees, can access TB preventive treatment. We must strengthen our efforts to identify and provide TB preventive treatment to around three contacts for every person diagnosed with TB so that we can close this prevention gap, prevent infection and transmission, and save more lives.”
In Blantyre, Malawi, MSF supported a TB programme in Chichiri prison: the programme screened for and treated people with TB and provided TPT for people with latent TB infection and people living with HIV. In 2019, the programme screened 1,500 people, and nearly two-thirds of those screened were started on TPT (666 HIV negative individuals and 324 people with HIV).
"In Khayelitsha, MSF had provided TPT for children and adolescents who are contacts of people with drug-resistant (DR) TB. The COVID-19 pandemic required us to adapt our programme to start providing home-based care, leading to an increase in children and adolescents started on TPT,” said Sister Ivy Apolisi for MSF’s DR-TB post-exposure programme.
TPT implementation lags partly due to a lack of access to the best tests and drugs. Most people only have access to the older TPT drug (isoniazid) that requires taking pills for 6-9 months. But a newer and shorter 1- to 3-month preventive treatment (rifapentine + isoniazid) exists, although it is more expensive (about R69 rand to R369 per month for the 3- and 1-month regimens respectively, versus about R8 per month for the older single isoniazid-based regimen). In addition, quality-assured rifapentine is only produced by two manufacturers because of limited demand, despite rifapentine having been off-patent for years, and it is not available in a child-friendly formulation. Further research into innovative alternatives that would make TPT easier, including long-acting injectable formulations of TPT drugs, would encourage more significant scale-up.
Issued by MSF