Emily Bell: An Ancient Disease Has Made a Deadly Resurgence

The Who Cares? Campaign blog is exploring tuberculosis (TB) for the month of March.

Tuberculosis (TB) is an airborne, bacterial disease that has been around for centuries. In fact, scientists now estimate the disease may have existed 3 million years ago! We now have the tools to diagnose and treat this deadly disease, but almost 2 million people continue to die each year. This is unacceptable.

Those who are infected with and die of TB predominantly live in the poorest communities of the world. A disease of poverty, TB generally affects the most marginalized communities who are also affected by malnutrition, HIV/AIDS, and malaria. They lack adequate access to clean water and basic healthcare.

Sub-Saharan Africa, therefore, faces a particularly high burden of TB with the largest number of TB-related deaths. Tanzania is hard hit, with TB responsible for taking more than 32,000 lives per year. In fact, TB has made a deadly resurgence in Tanzania and elsewhere in sub-Saharan Africa over the past two decades in large part to the spread of HIV/AIDS. The HIV/AIDS pandemic presents a multitude of challenges in tackling TB:

• People who are HIV-positive are more susceptible to TB infection due to their weakened immune systems. This fuels the spread of TB.
• TB is more difficult to diagnose among people who are co-infected with HIV. People who are co-infected often suffer longer before accessing treatment and may also spread TB to their loved ones unknowingly.
• TB is harder to treat among people with HIV. The antibiotic drug regimen to combat TB must be carefully coordinated with other medications, such as antiretrovirals.

Dr. Fred Lwilla, senior program officer for Tanzania’s National TB and Leprosy Program, noted that the number of reported tuberculosis cases is increasing in Tanzania in part because of high HIV prevalence, weak health infrastructure and poverty, according to a recent Tanzanian publication. He cited lack of public awareness and insufficient integration between TB and HIV/AIDS programs as additional obstacles.

The extreme shortage of doctors, nurses, laboratory technicians and other critical healthcare workers in Tanzania makes diagnosis and treatment of TB even more challenging. Treatment, for example, requires a minimum six-month course of antibiotics. Community health workers have proven instrumental in providing daily observed treatment (DOT), but patients often require periodic follow-up with a doctor, especially if they face complications due to HIV/AIDS.

Emily Bell is Head of Advocacy and Communications at the Touch Foundation. She was formerly a Program Officer at the Open Society Institute, where she oversaw a TB monitoring project that focused on several countries, including Tanzania.