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Uniting to combat TB, a global perspective

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Uniting to combat TB, a global perspective



In 2021, the World Health Organization (WHO) removed Zimbabwe from the 30 TB high burden countries list.
Cambodia and the Russian Federation made strides in TB diagnosis and management and were removed, too.
TB remains one of the major causes of death in Zimbabwe, with a TB-HIV co-infection of 70% of those tested for TB also testing positive to HIV.
The Ministry of Health and Child Care’s (MoHCC) National TB Program (NTP) has scaled up TB diagnosis.
Dr Fungai Kavenga, Deputy Director, TB Prevention and Control, Ministry of Health and Child Care) spoke of scaling up TB services aiming to leaving no one behind.
“TB treatment is free of charge in Zimbabwe and is available in the public sector. There are strong support mechanisms that are in place to support patients to complete their TB treatment.

“We do have a little bit of public private mix where a few selected private facilities offer TB treatment, e.g., Hwange Colliery, Tongaat Hullets… These facilities are supported and guided to ensure treatment is offered according to national guidelines,” said Dr Kavenga.
For TB treatment, the country now uses the shorter and safer regimens.
“The NTP introduced shorter and safer preventive TB treatment regimens. Child-friendly formulations and a shorter all oral treatment regimen for treating multi drug resistance tuberculosis (MDR-TB are in use.
“The NTP is conducting targeted active TB screening in high-risk communities using mobile X-ray trucks,” said Dr Kavenga.
“Zimbabwe has also deployed point-of-care and decentralised molecular test Truenat dianostic machines since December 2021. This has resulted in increased notification of new cases as well as those with rifampicin resistance TB,” said Dr Kavenga.
In Zimbabwe, around 40% of people with TB were missed by services in 2022 (WHO GTB Report 2023). However, all the remaining 60% of people with presumptive TB got tested on molecular diagnostics in the country (100%).
With evidence-based approaches to reach the unreached people with TB (40%), Zimbabwe can find all TB and link them to care.
Despite these strides, Zimbabwe still faces challenges in the fight against TB. The high out-of-pocket costs are indirect costs. These costs entail travelling costs, good nutrition and treatment besides TB or HIV, which is free. Treatment for other conditions requires payment.
When battling TB in the early months, usually after presenting late at the hospital, one is very ill with loss of income.
A 2020 preliminary TB review of cohort analyses in the District Health Information System 2.3 indicated concerning percentages of leakages where 17% of presumed patients in Chegutu District did not have specimens sent to the laboratory for investigation and 11% of those who submitted specimens did not receive results.
However, lost samples will be a thing of the past following the rollout of an Integrated Specimen Transportation (IST) system in 2021.
Implemented by the MoHCC through the Biomedical Research and Training Institute (BRTI), the program is financed by the UNDP/Global Fund project.
Today, the program nationally covers 2000 health facilities under the MoHCC using bike riders.
The IST project uses a hub and spoke model where bikers and drivers transport specimens from lower-level facilities known as spokes. From the lower level clusters to district, either a mission hospital laboratory, which are the Hubs.
IST has greatly improved turnaround time with results received.

With world leaders United Nations High Level Meeting (UNHLM) having committed to tuberculosis TB-related SDG targets, which include achieving at least 80% reduction in TB incidence by 2030. They aim for 90% reduction in TB deaths by 2030 and zero catastrophic costs for TB-affected families.
With the Stop TB Partnership and United States Agency for International Development (USAID) supporting the use of new tools, countries are reporting a significant increase in new TB case notifications, and linkage to treatment and care.
More importantly, it has helped high TB burden settings reach the unreached by deploying point-of-care, decentralised, battery operated, and laboratory independent TB screening and diagnostic tools in peripheral and remote settings.

Innovative ways to recharge these tools, such as the use of solar power in Democratic Republic of the Congo and Nigeria, have made it possible to tide over challenges like lack of electricity or unstable power supply.
This is the largest-ever rollout globally of the only WHO recommended point-of-care, decentralised, battery-operated, and laboratory independent molecular test Truenat.
A representative from Uganda told the Call to Action, Accelerating TB Treatment Conference that took place in Goa, India, in May that TB screening went by 33%.
“New tools, the portable mobile X-Ray, Truenat point-of-care have been deployed based on patient load, distances from already existing labs, and regional balance TB screening of those with presumptive TB went up from 2173 in 2021 (prior to introducing new tools) to 2811 in 2022, and new TB case notification increased by 33% between 2021-2023,” he told the gathering .
Dr Elom Emeka, Director of Laboratory Services, National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, in the Ministry of Health, Nigeria Nigeria, presenting virtually said there was greater uptake of TB services as treatment went to the communities.
“In Nigeria, 41% of the TB cases were missed by services in 2022 (WHO GTB Report 2023). Nigeria is one of those countries that have included Truenat in their national guidelines for diagnosing TB. Nigerian NTP is deploying ultraportable X-ray and molecular test Truenat (with solar panel for recharging) in remote or difficult to reach areas with unstable (or no) power supply across the country. Efforts for demand creation of standard TB services has resulted in greater uptake from the communities of the state-of-the-art TB diagnostics and treatment support,” said
Dr Elom Emeka, Director of Laboratory Services, National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Ministry of Health, Nigeria.
With commitment at the highest level, implementation of plans can see the targets being achieved.
Abuja Declaration, an agreement signed by African leaders in Abuja, Nigeria, in 2001 agreed to committing at least 15% of national budgets to the health sector. Zimbabwe is still set to fulfill the declaration.

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