Costly Crisis, Frontline Fight, Better Regimens
TB in Tidbits News Scan
Costly Crisis
In a dispatch for the Center for Global Development, Anthony McDonnell reflects on the devastating impact of US foreign assistance cuts to ongoing efforts to combat drug resistant-TB:
The pause in foreign aid threatens to turn back the clock on TB progress at a moment when the world cannot afford another global health crisis. If funding is not restored quickly, in a way that sees treatments reach the people who need them, then MDR-TB will rise and more lives will be lost. The initial impact will be felt in high TB burden countries, but the repercussions will ultimately come back to haunt Americans, and a preventable disaster will unfold.
McDonnell also shares some alarming estimates on the costs associated with treating a projected global spike in resistance and cases:
At the moment in the US, 8.5 percent of TB cases are resistant to the first line treatment Isoniazid, and within this group, 1.4 percent of TB cases are MDR-TB. If all of the Isoniazid-resistant TB cases became MDR-TB cases, the cost of treating MDR-TB would increase by over $100 million a year. If, on top of this, TB rates rise at twice the current rate to over 30 percent a year, then the cost of treating TB would rise to almost a billion USD a year by the end of the administration, and more than two and a half times as many Americans will die from TB during the current Trump administration than under Biden. It’s possible that the impact could be far worse than this. Globally, the rate of TB is almost fifty times higher than in the US, and the MDR-TB rate is over 100 times greater. Whilst it is unlikely that American rates will rise to this average in the short term, if they do reach this level it would see the cost of treating TB increase to over $11 billion.
Frontline Fight
The Global Fund just released an incredibly compelling visual post profiling a volunteer-run mobile health program delivering critical services for TB patients in the Donetsk region of Ukraine.
The mobile teams, usually comprising 10 medical workers and support staff, work on convoys of white vans equipped with a robust set of the latest medical tools and modern devices. The teams provide on-the-spot consultations as well as diagnostics and treatment for a range of infectious and non-communicable diseases including HIV, tuberculosis (TB), heart disease and others. They prioritize reaching communities hit hardest by the war – communities that have been completely cut off from health services.
We strongly recommend clicking through the entire piece, as the photography included really does capture the courage and selflessness of these heroes. Be sure to also check out the corresponding YouTube video the Global Fund produced, featuring interviews from two of these frontline workers – Dmytro and Yulia.
Out of Options
Writing for The Nation, Leon Lidigu and Brygettes Ngana demonstrate the very real consequences US assistance cuts have had on the thousands of TB patients in Kenya, including Walter Thomas, whose access to safe and reliable medication was abruptly cut off.
Walter notes that despite the progress Kenya has made in the fight against TB, President Donald Trump’s stop order on foreign aid that saw the shutdown of USAID, which the country has been relying on in its quest to eliminate the deadly disease, has immensely affected his treatment.
“I have few pills left and so I have been frantically calling the facilities that used to give me the drugs, and they have none, which has me worried. That is why this morning I have decided to go to Mbagathi and see if I can find them.”
Later in the piece, the authors also review some of the other withdrawal-related impacts: sample testing backlogs, medication adherence challenges and TB workforce constraints.
A Helping Hand
Partners in Health spotlights the recovery journey of Kioshi Vásquez, a young Peruvian man who was diagnosed with MDR-TB in December 2023. The piece highlights the wide-ranging challenges Kioshi and other patients face in dealing with an MDR-TB diagnosis and showcases the extraordinary lengths care providers will go to help patients on the mend.
As he coped with the shock of his diagnosis and the debilitating side effects of treatment, which left him exhausted and sometimes reluctant to continue, the SES team began visiting him at home.
"This way, we monitored his treatment, learned how he was feeling, identified his needs, and assessed what kind of support we could offer him. We also went to the health facility to help coordinate his care, whether it was testing or medical consultations," Valdivia explained.
The support not only ensured that Vásquez continued treatment but also addressed social difficulties that could jeopardize his recovery. He received food supplies, clinical evaluations, and ongoing psychological support.
Over time, the fear and uncertainty that had marked the beginning of his treatment began to dissipate. He still had a long road ahead, but he was no longer alone.
Integrated Approach
UNDP has a new post celebrating the remarkable turnaround taking place in Belarus, a country that has historically struggled with high rates of TB. The article explains how a system-wide embrace of a more holistic approach to treating tuberculosis has helped successfully bring down nationwide incidence rates.
At the end of 2024, Minsk hosted a specialized training program for phthisiatricians - medical practitioners focused on the diagnosis, treatment, and prevention of tuberculosis, regardless of the organs or systems it affects. The course emphasized an integrated approach to managing tuberculosis patients, including those with drug-resistant forms of the disease and latent tuberculosis infections. This holistic method, which considers the entire body in the treatment process, has proven to be particularly effective in addressing the complexities of the disease.
This advanced training has equipped the participating phthisiatricians from all Belarus’ regions to implement more effective, personalized treatment plans tailored to the unique needs of each patient. For instance, a patient with hepatitis and tuberculosis can now receive combined therapy that combats both conditions concurrently. Similarly, those with diabetes can be treated in a way that manages their tuberculosis without exacerbating their chronic disease.
Support Gap
Recapping the findings from a recent RNOH/GIRFT National TB report review, Pharmaceutical Journal’s Sasa Jankovic flags one very concerning result: many UK pharmacists are simply not as engaged in helping their TB patients.
The report noted that while “pharmacy time was essential” for TB services, “it was disappointing that the role of pharmacy in TB services was poorly recognised, being absent in 43% of services”.
The report added that it should be the responsibility of providers and integrated care boards (ICBs) that a senior pharmacist of band 7 or higher should be attached to and support each TB service on a pro rata basis. It also recommended that the role of pharmacy support for regional multidisciplinary teams should be included in the future development and funding of such services.
When engaged, pharmacists can play an important role in combatting tuberculosis because they are often a “first point of contact for people with symptoms suggestive of TB.” But beyond screening and detection, they can also support medication adherence, and help ensure continuity of care for TB patients.
Better Regimens
Harvard Medical School science writer Jake Miller summarizes some of the important findings from a recent endTB study testing alternative drug regimens for TB patients:
[I]n a major step forward, an international clinical trial has found three new safe and effective drug regimens for tuberculosis that is resistant to rifampin, the most effective of the first-line antibiotics used to treat TB.
The newly identified regimens take advantage of recently discovered drugs to expand the treatment arsenal and give physicians new ways to shorten and personalize treatment, minimize side effects, and treat patients using only pills instead of daily injections. They also offer alternatives in case of drug intolerance, medication shortages or unavailability, or drug resistance, the researchers said.
The study was led by HMS researchers, who worked in conjunction with MSF, IRD, PIH and other international organizations.
Reset Opportunity
In a spirited opinion piece, the Editors of Leadership call on the Nigerian government to use the current funding shortfalls as an opportunity to encourage the realization of a more sustainable pathway for providing TB services.
[A]s international funding faces uncertainty, Nigeria must increase domestic financing for TB programs. Relying on external donors for three-quarters of our TB response not only compromises our sovereignty but subjects our public health priorities to foreign policy considerations.
The government must fulfill its pledge to allocate at least 15 percent of the national budget to healthcare, with specific earmarks for TB control reflective of the disease’s outsized impact.
The World TB Day should serve as a catalyst for action, not merely symbolic recognition. We can choose to continue the pattern of underfunding and fragmented interventions, consigning hundreds of thousands more Nigerians to preventable suffering and death. Or we can seize this moment to demonstrate true leadership by making the necessary investments and implementing proven strategies at scale. The choice before us could not be clearer, nor the stakes higher.