Opinion | Healthcare

CDC answers call for accountability in global tuberculosis response

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Nine-year-old Mpilo (this is a pseudonym) had been sick for months, suffering from fever, loss of appetite and persistent cough. His mother made the long journey with him and his sister to the nearest rural health clinic in South Africa to seek treatment as his sister also had a leg wound. 

Through a U.S. Centers for Disease Control and Prevention (CDC) program with health facilities, as part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), doctors discovered that both children were HIV-positive.

They also found that Mpilo had tuberculosis (TB) - a potentially deadly combination. Doctors started Mpilo and his sister on a daily regimen of HIV antiretrovirals and immediately began TB treatment for Mpilo. 

While preventable and curable, TB remains the leading cause of death worldwide from an infectious disease. People living with HIV (PLHIV) and exposed to TB have a more than 20 times greater risk of developing and dying from TB than other groups.

Young children have more than 10 times greater risk. These odds weren't good for young Mpilo, but today he scampers around the backyard and rides his bike through the nearby hillside. His treatment and transformation represent hope and our ability to stop the devastation and spread of the HIV and TB epidemics. 

Just over one year ago, at the United Nations High Level Meeting on Tuberculosis, global leaders recognized the continuing threat of TB, including the growing numbers of multi-drug resistant cases of which fewer than 20 percent are cured. The airborne disease claims more than 4,000 lives a day among the 10 million new cases every year.

Global leaders unanimously signed the "Political Declaration on the Fight Against Tuberculosis," reaffirming the ambitious END TB targets and committing themselves to deliver funding to provide 40 million people worldwide with treatment to cure TB by 2022; provide an additional 30 million people with treatment to prevent TB; and support research to find, cure and prevent the disease.

Where is the global health community one year later with these targets? Earlier this month, at the 50th Union World Conference on Lung HealthIndia hosted the largest gathering of TB scientists who demonstrated how science, leadership and action are shaping the response to the TB epidemic to achieve these ambitious global goals.

India, the country with the highest TB burden with roughly a quarter of the world's cases and more than 11,000 people co-infected with HIV and TB, plays a critical role in preventing new cases and stopping transmission and has responded with a plan to eliminate TB by 2025. The U.S. government remains the largest single donor for research, development and programs in this fight.

The U.S. CDC is responding to the global call for accountability and action by disseminating scientific and technical knowledge from its domestic TB program, which has prevented up to 319,000 cases of TB in the United States and averted up to $14.5 billion in costs over the last 20 years, as well as research and programs around the world on TB prevention, detection and treatment and forging strong technical partnerships with Ministries of Health.

In the area of TB disease prevention, evidence shows that TB preventive treatment (TPT) when paired with antiretroviral therapy, can lead to marked reductions in TB deaths among children and PLHIV with latent TB infection by up to 80 percent, and it is the most effective, inexpensive way to prevent TB disease, its transmission and death.

Reaching children and PLHIV with TPT is a priority for CDC as one of the leading implementing partners of PEPFAR.

In 2017, fewer than 1 million PLHIV and children had ever received TPT. CDC's efforts, using data-driven strategies and partnering with countries, have tripled that number in less than two years, and we remain on track to reach more than five million eligible people by 2020.

CDC's scientific leadership has provided key evidence to deliver effective and efficient programs and has demonstrated the feasibility of massive, rapid scale-up of this life-saving medication. For example, Uganda is nearing the end of a 100-day campaign to provide TPT to nearly 300,000 people, yielding positive results.

Kenya has provided TPT to nearly 900,000 eligible people - almost 90 percent of all PLHIV in country - since pairing TPT with antiretroviral therapy for HIV. As a result, the number of new TB cases among adults and children with HIV has fallen by more than 40 percent in Kenya. 

These actions represent great strides in preventing new infections and saving lives, but the stakes remain high, and every country must answer the call to end the global TB emergency. Just over one year ago, we stood at a critical juncture with an opportunity to elevate worldwide leadership and commitment in the fight against TB.

Today, CDC, working with countries and national and global partners, remains laser-focused on the commitments made to achieve lasting impact in stopping the threat that TB poses to our national and global health security.

Rebecca Martin, Ph.D., is the director of CDC's Center for Global Health.

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