New tests and drugs for TB – world’s deadliest infectious disease – remain out of reach

Critical medical innovations for tuberculosis (TB) are reaching only small numbers of the people who urgently need them because many countries' national policies are still not in line with new World Health Organization (WHO) guidelines, says a new report from MSF and the Stop TB Partnership. Step Up for TB surveys 37 countries with high burdens of TB.

As the COVID-19 pandemic threatens to derail the global response to TB, MSF calls on governments to accelerate TB testing, treatment, and prevention. Donors must provide the financial support needed to ensure increased access to new medical tools for diagnosing and treating millions of people with this killer disease, the organisation said.

“Instead of stepping up for TB, we are at risk of slipping back due to COVID-19,” said Sharonann Lynch, senior TB policy advisor for MSF’s Access Campaign. “We cannot stress enough how urgent it is now for governments and donors to intensify their efforts so that critical medical innovations and tools reach people with TB. We finally have better drugs and tests to tackle and prevent this extremely infectious yet curable disease, so it’s both mind-boggling and unacceptable that they’re still not being used to save as many lives as possible.”

In October, whilst reporting on the severe impact of the COVID-19 pandemic on TB services, WHO reported a sharp drop in the numbers of people being diagnosed with TB. It advised countries to adopt and roll out better testing policies and practices, as well as catch up to ensure existing TB services are maintained.

Testing
The report shows that countries continue to fail to roll out up-to-date testing policies that could help reach the many people still being missed. In 2019 - before COVID-19 - an estimated three million people with TB were either not diagnosed or were not notified to WHO.

85% of countries surveyed still do not use the lifesaving point-of-care urinary TB LAM test for routine diagnosis of TB in people living with HIV, as recommended by WHO.

“As clinicians working on the frontlines of the raging TB epidemic, it is distressing to see the sluggish uptake of TB LAM in national treatment programmes, despite its proven role in saving the lives of people living with HIV,” said Dr Patrick Mangochi, deputy medical coordinator for MSF in Malawi. “Countries must step up the use of TB LAM as a core component of testing services, otherwise delays in diagnosing people with TB and getting them started on treatment will continue to fail people with HIV who get TB.”

Reducing visits to health facilities
The implementation of WHO guidelines by reducing visits to health facilities without disrupting treatment is urgently needed to minimise the unnecessary risk of COVID-19. The report finds that only 22% of countries surveyed allow TB treatment to be started and followed up at a primary healthcare facility and medicines to be taken at home, rather travelling to a hospital, for example. Countries must take immediate action to implement people-centered TB policies, including treatment initiation and follow-up at primary healthcare facilities.  

Toxic injections
National treatment programmes must prioritise the use of all-oral treatment regimens for people with drug-resistant TB (DR-TB) that no longer include older, toxic drugs that have to be injected and cause serious side effects. 39% of countries surveyed do not use a modified all-oral shorter treatment regimen and 28% are still using injectable medicines when treating children with DR-TB.

“I have been through an agonising journey of being treated with medicines with excruciating side effects, and lost one of my lungs," said Meera Yadav, a survivor of extensively drug-resistant TB (XDR-TB) in Mumbai, India. “Finally, in 2016, I was able to access newer TB drugs as part of the regimen that saved my life. I don't want anyone else to have to go through this ordeal. With newer medicines, it is now possible to give people all-oral treatment that works to cure them. People with TB can’t be excluded from accessing these innovations anymore, especially when they are afraid to visit treatment centres due to COVID-19.”

Notes to editors:

TB remains the world’s top infectious disease killer, with more than 10 million people falling ill and 1.4 million people dying due to this disease in 2019.

The 37 countries included in this report are home to 77% of the global estimated TB incident cases and 74% of global estimated rifampicin-resistant cases. They are: Azerbaijan, Bangladesh, Belarus, Brazil, Cambodia, Central African Republic, Democratic People’s Republic of Korea, Democratic Republic of the Congo, Eswatini, Ethiopia, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Lesotho, Liberia, Malawi, Mozambique, Namibia, Nigeria, Pakistan, Papua New Guinea, Philippines, Republic of Moldova, Russian Federation, Sierra Leone, South Africa, Tajikistan, Thailand, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Vietnam, Zambia and Zimbabwe.