If we are to end TB then we cannot ignore preventing TB
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With quarter of world's population infected with latent TB (not active TB disease), and in the light of scientific fact that every new case of active TB disease comes from this pool of population infected with latent TB, the writing on the wall is clear: we cannot put TB prevention on the blindspot anymore if we are to eliminate TB globally.
"TB is the biggest infectious disease killer worldwide. With 10 million people with active TB disease every year and 1.6 million deaths (300,000 of these deaths were among people living with HIV), the challenge is enormous. People living with HIV get not just pulmonary TB but also extrapulmonary TB. Drug-resistant TB is a growing threat in Peru and worldwide. It is important to prevent TB as well as to give early diagnosis, proper treatment and care to everyone in need. We need to recognize that in developing countries which are TB high burden nations too, proportion of population infected with latent TB is very high, up to 50%. Latent TB can 'wake up' and cause active TB disease due to range of factors including HIV, or therapies for cancer, immune disorder, organ transplant, etc. We have to prevent TB if we are to end TB" said Dr Eduardo H Gotuzzo, Emeritus Professor, Universidad Peruana, Peru. Dr Eduardo was speaking at the TB HIV Symposium with CNS which was organized around the 10th IAS Conference on HIV Science (IAS 2019) in Mexico.
We knew how to prevent TB since 60 years: Why delay?
TB is preventable, treatable and curable: This is scientifically true but not in lives of over 10 million people who got TB disease and over 1.6 million people who died of TB in 2017. We need to walk the talk on the scientific fact that TB can be prevented, and accurate diagnosis, proper treatment and care must become a reality for all those with active TB disease as well as latent TB infection.
Prof Harry Hausler, Chief Executive Officer of TB HIV Care in South Africa, agreed: "TB preventive therapy has been around for a long time but its rollout has been suboptimal. South Africa is a country that has the biggest implementation of TB preventive therapy as well as antiretroviral treatment in the world. More than 400,000 people on TB preventive therapy were initiated last year but that's still 53% of people who are newly enrolled in HIV care. We have another 4.4 million South Africans living with HIV who are already on antiretroviral treatment, but we do not have data to say what proportion of them have access to TB preventive therapy. So, we really do have a long way to go."
Rooting right to TB prevention, diagnosis, treatment and care, in core principles of medical ethics, Prof Hausler explained: "There are four main principles of medical ethics: beneficence, which means do what works; non-maleficence, which means do no harm; autonomy, which means allow people to choose; and justice, which is linked to access.
Beneficence: do what works
Added Prof Hausler: "From the point of view of beneficence we know that TB preventive therapy works very well: we have different TB preventive treatment options, such as, six months of isoniazid (INH) therapy; and new regimens that are in the latest WHO guidelines - 3 months of weekly rifapentine INH which works as well as three months of rifampicin and INH."