Brad Tytel: Sustained Voices Will Lead to Sustained Commitment
One of my TB heroes—a man who has dedicated his life to stopping the disease—tells a story about how he first got involved with a killer everyone else seemed to have forgotten.
In 1990, he was a doctor at Muhimbili Hospital in Dar es Salaam, Tanzania. It was the first time he saw how TB and HIV conspired to kill more patients than over-stretched and under-funded health systems had any hope of treating. The hospital had only 3,000 beds for nearly 6,000 patients, so patients with HIV and patients with TB ended up doubled up in the same beds. Looking back, it is easy to see a recipe for disaster: patients with infectious TB in close quarters with highly immune-compromised neighbors. But the TB diagnostic was lousy, and by the time he and other doctors knew a patient had TB, that patient had almost certainly infected dozens of others.
With stories like these, why doesn’t TB have us all marching through the streets? Nearly two million people each year are dying of a disease that developed countries such as the U.S. “defeated” half a century ago. Twenty years after Muhimbili, the most commonly used diagnostic is still lousy and misses up to one-half of all TB cases. The drugs are old, have unpleasant side effects and take a minimum of six months to treat a patient. If patients don’t complete treatment—whatever the reason—they may develop and spread a more deadly form of drug resistant TB. There are doctors and nurses in the field doing their heroic best to stop the TB epidemic. But without more resources and new and better tools TB will continue to spread.
TB needs strong champions to push back against the neglect that led to a resurgent epidemic. If the history of the HIV/AIDS epidemic has taught us anything, it’s that effective advocacy and communications can shape the international response to a disease. At the grassroots level, TB patients, doctors and community activists need to demand better access to, and tools for, treatment and prevention. At the national and international level, advocates have to make the case for increased funding for healthcare and investments in research that will lead to improved tools and methods.
Fortunately, much progress is being made. Passionate, engaging and effective TB patient advocates and grassroots organizations have emerged, either independently or with support from international TB or HIV organizations. Many of these activists are joining forces with colleagues focused on other disease. At the November 2009 Multilateral Initiative Against Malaria Conference in Nairobi, Kenya, I witnessed a sizable and impressive demonstration convened with the help of several TB groups that called on President Obama and other leaders to meet their commitments to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
At the international level, funding for TB prevention and control has increased significantly, particularly through the Global Fund, UNITAID, and the US government. This is largely due to the efforts of TB advocacy organizations and increased attention to the dangers of TB/HIV and drug resistance. At the same time, many high TB burden countries, particularly those with emerging economies like South Africa, China and India, are now taking increased steps to stop TB—and there is hope that these gains could translate into assistance for countries like Tanzania.
There is still an enormous amount of work to do, and resources available for TB are still a fraction of what is needed. But sustained voices will lead to sustained commitment. By telling stories like that of Muhimbili and using those experiences to push for change, we can draw renewed attention to an ancient killer.
Brad Tytel is a Director at Global Health Strategies, an international consulting company that uses advocacy and communications to help ensure development and worldwide delivery of health technologies and information – including for TB.
Photo captions: Activists in Nairobi, Kenya, call on donor governments to stop TB, AIDS and Malaria – November 2009. Credit: Global Helath Strategies
Heather Ignatius — Community Outreach is an Essential Component of TB Research
Mbeya CAB members march to spread awareness about the TB trials taking place in their community.
TB kills nearly 5,000 people a day—that’s 1 person every 20 seconds. Of the 1.8 million TB deaths each year, over 90% occur in developing countries, further exacerbating poverty among the world’s poorest and most vulnerable populations. Fueled partially by a high burden of HIV, Tanzania is among the nations hardest hit by the TB epidemic.
For those affected with TB, successfully completing treatment is extremely challenging. TB treatment relies on 4 drugs administered over a period of 6 – 9 months, and often includes daily observation. In low-resource settings, the requirements of treatment place a tremendous burden on patients and health systems alike. The hardships of administering and completing TB treatment, including the accompanying side effects, cause many to stop taking their medicine prematurely. This leads to the development of drug-resistant TB, which is much more deadly and much more difficult and costly to treat.
The challenge of completing TB treatment is further complicated by dangerous drug interactions between TB drugs and certain anti-retrovirals commonly used to treat HIV. For the millions infected with both TB and HIV, treatment of one disease is often interrupted to administer treatment of the other.
However, recent developments in TB drug development offer hope for the future. After decades of stagnation in research and development, the first new TB drug candidates in more than 40 years have reached the clinical testing phase. One drug, which has the potential to reduce treatment to 4 months, is currently being tested at two sites in Tanzania: the Kibong’oto National TB Hospital near Moshi, and the Mbeya Medical Research Programme (MMRP) at Mbeya Referral Hospital.
As a component of this clinical trial, the Tanzanian sites have implemented community engagement programs to ensure that the communities in which they work are aware of and educated about the research.
Drawing clients from a catchment area that spans several communities across Mount Kilimanjaro’s foothills, Kibong’oto Hospital offers primarily in-patient TB care, as patients are unable to make the daily trek to receive observed treatment. The hospital staff has set up a permanent outreach department for the patients’ families and communities, as well as a Community Advisory Board (CAB)—a group of 15 local community leaders and health outreach workers who educate others about TB and the trials being conducted at the hospital and related issues.
The Kibong’oto community engagement program finds that holding public educational events on the Hospital’s grounds helps bridge the gap between the medical staff and the community. One notable event last year included an art competition open to local students. The winners’ artwork was featured in educational materials on TB disease that were disseminated in the CAB’s outreach in an effort to raise awareness and combat stigma. This year on March 24, World TB Day, the hospital will host an Open House and quiz show to educate the community about TB.
A theatre troop performs for World TB Day to educate the community about TB.
In the more urban Mbeya, community outreach by the MMRP has used call-in radio shows and theatre performances to educate the surrounding community about the issues associated with TB.
The local CAB, originally developed around participation in a previous HIV trial, consists of about a dozen community leaders such as lawyers, educators and religious leaders. This group took it upon themselves to learn about TB diagnosis, treatment, and research and expand the scope of their educational efforts. On World TB Day, the Mbeya CAB will hold its second annual march to raise awareness about the TB trials taking place in their community.
Heather Ignatius is Policy Manager at the Global Alliance for TB Drug Development, which is a not-for-profit, product development partnership accelerating the discovery and development of new tuberculosis drugs that will shorten treatment, be effective against susceptible and resistant strains, be compatible with antiretroviral therapies for those HIV-TB patients currently on such therapies, and improve treatment of latent infection.
Photo credits: Mbeya Medical Research Programme
Habari — Liz Pavlovich: Weill Bugando University hosts first research symposium
Recently I learned that 60 percent of all babies born in sub-Saharan Africa are not born in a health facility, but rather, in the unsanitary and ill-equipped conditions of the home. This primarily happens in rural villages where women are not able to reach a health facility easily because of the distance or lack of transport and money.
If women bring their baby to the health facility after delivery, more than half of the time it is too late and the child dies. As a result, the odds are stacked against babies who are not born at health facilities. Nearly five times as many of these newborns die within the first couple of days than those babies born at facilities due to hypothermia, sepsis (inflammation of the entire body due to an infection) and other complications, compared to those born in health facilities.
This was just one of the research findings presented by Bugando University faculty and staff at the first research symposium hosted by this eight-year o
ld university in Mwanza, Tanzania. The National Institute of Medical Research (NIMR) provided their brand new facility for the symposium, which accommodated about 300 people anxious to share knowledge about critical health topics such as HIV/AIDS, tuberculosis and other serious conditions and diseases prevalent in sub-Saharan Africa.
The importance of conducting research at academic institutions could not be emphasized enough by the keynote speaker, Dr. Kapiga. Research opportunities provide fuel for academic institutions such as Bugando to attract well-qualified faculty, offer exciting extracurricular activities to students, gain additional funding and integrate themselves into the international exchange of knowledge. Not to mention that research findings enable medical practitioners to better assist their patients, drug companies to improve treatments, and governments to better help their populations. With the findings I shared earlier, we better understand how important it is to the survival of newborns for the mother to deliver in a facility with the proper equipment and staff. This could justify the need for governments and organizations to provide education programs in rural communities that encourage women to go to health facilities for antenatal care and delivery or, likewise, encourage the training of greater numbers of health workers who are equipped to do outreach work in rural areas.
In sub-Saharan Africa, the opportunity to do research is very low because of lack of funds and facilities. It was very exciting to see Bugando showcase their hard work last week despite these inherent challenges. The Touch Foundation and other partners of the university will continue to support Bugando’s drive to conduct research. Ultimately, this research will generate knowledge that will help to improve health conditions in sub-Saharan Africa.
Habari – News From Bugando – is a periodic blog posting by Liz Pavlovich, a Program Officer for the Touch Foundation who is based in Mwanza Tanzania. Since 2004, the Touch Foundation (www.touchfoundation.org) has been working with Tanzanian partners to address the health worker shortage by expanding the Bugando regional medical training college and teaching hospital. Bugando’s University is the second largest of five institutions training medical doctors in the country. It also trains health workers in seven other disciplines – post-graduate MDs, nurses, assistant medical officers, radiographers, pharmacists and laboratory technologists. The school is now training 900 students.