Why is tuberculosis (TB) an important focus for HAI?
Globally, more than 2 billion people have a latent form of tuberculosis, and an estimated 9 million develop active disease each year. Of these, almost 500,000 have multi-drug resistant TB (MDR-TB), a particularly challenging form to treat. TB kills over 1 million people annually. It remains largely a disease of poverty, and in sub-Saharan Africa it’s resurgence over the past two decades has been fueled by the HIV epidemic. TB remains the leading cause of death and morbidity for patients infected with HIV, and to successfully manage co-infected patients, countries are recognizing the need to treat these patients in an integrated and coherent fashion.
Despite recent advances in new, sophisticated diagnostics, improved treatment regimens and novel antibiotics for drug resistant TB, major challenges remain. Globally one-third of patients with active drug-sensitive TB are not diagnosed and treated each year, and 80-90% of patients with drug-resistant TB are not appropriately tested, diagnosed and treated. These untreated individuals continue to infect their family and community members by spreading TB through the air when they cough.
What is HAI doing to address the challenges of TB?
HAI in partnership with the Mozambican National Tuberculosis Program (NTP) is committed to helping reverse the tide of this epidemic. HAI and the NTP are executing several joint projects to better understand the TB epidemic in Mozambique, and to strengthen the TB, MDR-TB and HIV/TB co-infection health care delivery system.
Since 2011 HAI has partnered with the Mozambican NTP to pilot two new diagnostic platforms for TB. LED microscopes provide several advantages over traditional microscopy for TB including faster specimen process and fluorescent staining that makes it easier for lab technologist to identify the TB bacteria which improves the sensitivity of this test. HAI also piloted GeneXpert MTB/RIF, a rapid automated molecular test that identifies the DNA of TB in patient’s sputum, and looks for genetic mutations that confer antibiotic resistance consistent with MDR-TB. These were successful efforts, and both platforms are now being implemented nationally.
With the introduction of GeneXpert MTB/RIF, the Mozambican NTP is able to identify many more patients with presumed MDR-TB. Previously very few patients were tested or diagnosed with MDR-TB as this required TB culture and drug sensitivity testing which is expensive and only available in specialized biohazard laboratories. As a result the Mozambican NTP is in the process of rapidly revamping and increasing the capacity of the MDR-TB health care delivery system in Mozambique. HAI is providing the NTP with a MDR-TB technical advisor who is embedded within the national ministry of health to help support this process. MDR-TB treatment is changing significantly with the recent discovery of two new effective antibiotics and the introduction of shorter but effective MDR-TB regimens, but these need to be thoughtfully integrated into the existing MDR-TB health care delivery system. To do so HAI is partnering with the Mozambican NTP on operational research studies to evaluate the current TB, MDR-TB and HIV/TB treatment care cascade, and to develop plans for how integrate these new advances while simultaneously strengthening the current delivery system.
Finally HAI is working with the Mozambican NTP and other partners to design pilot and deploy a national electronic MDR-TB database that can effectively track patients and treatment outcomes, help project demand for laboratory testing equipment and drugs, monitor laboratory testing equipment, and provide real time monitoring and evaluation data.
While TB is a challenging problem in sub-Saharan Africa, HAI is privileged to be able to work with the Mozambican NTP to address this issue, and to hopefully be part of the solution.