Ending TB one barangay at a time
SHOBHA SHUKLA, BOBBY RAMAKANT - CNS
Using best of diagnostic tools we can find TB and treat TB to prevent TB and end TB
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"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has," had said the famous anthropologist Margaret Mead. Bearing testimony to this, a small group of people in Bantayan Municipality of Cebu, Philippines, has changed the lives of many people affected by tuberculosis (TB). TB, despite being preventable and curable, continues to be the deadliest of the infectious diseases in high TB burden countries.
Carrying innovative new diagnostic tools for TB in plastic tubs, they went from islet to islet on pump boats, braving inclement weather, to screen and diagnose people with TB. This resulted in a tremendous increase in TB case finding upfront: 316% rise in new TB case detection, and 1292% rise in screening of those with presumptive TB.
Imagine the difference it can make in the Philippines' fight to end TB if such interventions can be scaled up and become a norm.
As per the latest Global TB Report 2022 of the World Health Organization (WHO), out of the estimated 741,000 people with TB in the Philippines, only 321,600 were notified to the national programme, and over 60,000 lives were lost due to TB.
As early and accurate TB diagnosis is the gateway to TB care pathway (and breaking the chain of infection transmission), the Philippines has a two-fold task:
- firstly, it must ensure that it is reaching out to all those with TB (and not just 43/100), and
- secondly, it must use WHO-recommended molecular tests to diagnose TB timely and correctly. This paradigm shift in TB diagnostics is a critical entry point, not only to the full spectrum of TB-care cascade, but also towards ending TB in the country.
Ending TB - one barangay at a time with x-ray and Truenat
When the WHO recommended point-of-care, decentralised, laboratory-independent and battery-operated molecular test Truenat (made by Molbio Diagnostics), along with the ultra-portable and battery-operated x-ray made by Fujifilm, was deployed in Bantayan islets, new TB case notifications, as well as treatment success rate, increased manifold, confirmed Dr Samantha Tinsay, Municipal Health Officer, Bantayan Municipality, Cebu, Philippines. "TB is a disease of poverty. Unfortunately here in our island of Bantayan a lot of people have TB because of malnutrition and poor hygiene," she said. Malnutrition is the biggest risk factor for TB.
Using latest and state-of-the-art diagnostic tools in the Philippines was made possible in 2022 by introducing New Tools Project (iNTP) of the Stop TB Partnership and United States Agency for International Development (USAID), which has helped in the rollout of a package of latest innovations in diagnostics, treatments, and digital health technologies to strengthen TB care in high-burden countries.
Bantayan is the largest municipality of Bantayan island and it has 25 barangays (small townships) and one district hospital which is understaffed and undersupplied. These areas are also marked as geographically isolated and disadvantaged areas (GIDA). Most of the people here are fisherfolk or farmers and their income is Pesos 300-350 (USD 6-7) a day.
"During September to October 2022, we were able to screen 1774 people with presumptive TB by bringing these tools right to their doorstep. Most of them cannot afford to travel to the mainland for diagnosis or treatment. So we brought TB point-of-care testing to their doorsteps and saw a very high increase in case detection as well as in treatment success rate," said Dr Tinsay. "As TB diagnostic technology was brought to the people (and not the other way round), people were more open to getting tested for TB."
"When the going gets tough, the tough get going"
When Dr Samantha Tinsay began the introduction of these new innovative diagnostic tools in September 2022, extreme climate events--such as typhoons and storms--compounded the challenge. But it was sheer determination on her and her team's part to hop on a pump boat and brave the storms and typhoons to go from islet to islet and find TB, and treat TB.
"When we started this project in September 2022, it was the middle of the typhoon season. So one of the challenges we often faced was the bad weather conditions. It took a lot of teamwork and effort with my staff and the barangay healthcare workers and officials of the local health unit - It was an all-in-one effort supported by the community," shared Dr Tinsay.
The x-ray and Truenat molecular test were brought to the Bantayan Rural Health Unit, and packed in a suitcase with wheels for transportation. Both of these machines fitted well in a moulded plastic tub, and were transported via pump boats.
On 29 October 2022, Tropical Storm Nalgae, locally known as Paeng, hit the Philippines, and affected around 4.8 million people within a week. On that fateful day, Dr Samantha Tinsay and her team were en route to one of the islets with the diagnostics tools in tow. "We did not know that a storm signal had been raised, and that nobody should be travelling or working as we were out of the range of mobile signal. Nevertheless, rain or sunshine, we were working and could not have stopped as patients were already waiting at the clinic," said the spirited Dr Tinsay.
Making a difference
Because of the introduction of new tools, TB case detection went up from 110 in 2021, to 458 in 2022 (an increase of >316%). The number of people who got tested for TB also went up from 180 people in 2021, to 2506 people in 2022 (an astronomical increase of 1292%).
"TB treatment success rate has also increased to 97% in 2023," she confirmed. Average TB treatment success rate in the Philippines was 76% in 2021 as per the WHO report.
"These new innovative TB diagnostic tools are very crucial in the fight against TB, especially for people living in geographically isolated and disadvantaged areas. These tools can really help eradicate TB. Bringing these tools to the people in a country like the Philippines where TB is very rampant, will help end TB, one Barangay at a time," rightly said Dr Tinsay.
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