Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance

TB targets under threat


Clinic staff examine an X-ray to diagnose TB © India HIV/AIDS Alliance

The overall number of new TB cases is gradually declining globally, yet the number of multi-drug resistant TB (MDR-TB) incidences is alarmingly on the rise, meaning progress made in the TB response is at risk of being undermined.

It’s timely then that the 43rd Union World Conference on Lung Health (13-17 November) is focused on sustaining the global TB response. Despite progress, 8.7 million new cases of TB were reported in 2011 and TB remains the number one killer of people living with HIV, accounting for 25% of all HIV related deaths. This stark statistic shows how the TB and HIV epidemics are inextricably linked, which is why it’s vital to link the two responses from policy through to programming. The work of our Linking Organisation in Kenya (KANCO) shows how communities can be a key player in preventing the development of MDR-TB (case study below).

Gains and strains

51 million people have been treated for TB since 1995 and 20 million lives have been saved, according to WHO and there has been a sense of optimism and hope that global targets to halve the number of TB related deaths could be achieved.

Encouragingly WHO has reported that new drugs and technologies to tackle TB (including a new diagnostic device) are on the horizon. However funding and commitment from all the key stakeholders to develop and distribute better drugs and diagnostic machines is critical.

However, when key players in the TB response meet this month, it’s within a context of MDR-TB outpacing the response in many countries. As reported by The Lancet recently MDR-TB is now “up to ten times” more common in some countries than expected.

 “A sustainable TB response requires 360-degree commitment… [from] governments, health care systems, health professionals at every level, the media, communities, patients and families” says  Dr Nils E Billo, Executive Director of International Union Against TB, the organisers of the conference. Hear more from Dr. Billo here.

Out of the clinic, into the community

For TB to be controlled, many experts agree that better community engagement is needed. From our 20 years of experience of supporting community-led responses we know how important this is. At the global level the Alliance has participated in the development of WHO’s new Operational Guidance on integrating community-based TB activities into the work of NGOs and other CSOs, which uses the aptly named ‘ENGAGE-TB’ approach.

“The document provides guidance on implementing and scaling up integrated, community-based TB prevention, diagnosis treatment and care’’ says Dr Gitau Mburu, the Alliance’s Senior Advisor on HIV and Health Systems, who participated in developing the guidance.

“As the guidance says, NGOs and CBOs need to go beyond facility-based services and fully engage communities in TB activities” Dr Mburu continued.

The guidance gives a number of examples of community-based approaches which will make an impact on the response, including raising awareness, behaviour change communication and community mobilisation.

Some Alliance Linking Organisations are already supporting community-based organisations to implement some of these activities.

Door-to-door in Kenya

For instance, KANCO advocates for improved HIV and TB integration and engages communities in the response.

Evelyne Kibuchi, KANCO’s Senior TB Advocacy Manager tells us more about how former TB patients are an important part this work: “Recognising the key role of patients and communities in the response, the first ever group of former multi-drug resistant TB patients in Kenya has now been formed. They are committed to using their experience to educate communities and advocate for better TB control. Engaging former patients has been an effective strategy to sensitise communities on the importance of completing TB treatment, as this is one of the key factors in drug resistance.”

A recent example of this can be seen in a sensitisation exercise in Kianda village in Nairobi. Here, former TB patients joined volunteers who went from house-to-house and reached over 300 residents with TB information. A number of people who had defaulted on TB treatment were identified, counselled on the importance of completing treatment and referred on to services.

Read more about KANCO’s TB advocacy and sensitisation work here.

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