Africa now must focus and fund diagnostics that will address the latent Tuberculosis infection (LTBI) reservoir as it seeks to achieve TB elimination in high T.B burden countries under the search -treat and prevent approach.
TB experts suggest that additional diagnostic priority focus should be given to healthcare workers (HCWs) employed in hospital settings and exposed to occupational risk of acquiring TB, Prisoners, Paedriatics, miners, persons with human immunodeficiency virus (PWHIV) and persons exposed to the disease in the household.
Screening for latent TB in those at an increased risk for TB infection offers a moderate net benefit in preventing active TB and also will ease acceptance to initiation to TB preventive therapies (TPT) says the expert. But the challenge now is to ensure that the required diagnostics can be made available and affordable especially in T.B burden countries where they are mostly needed to provide accurate and cost-effective results in settings where, equipment and technical expertise may be limited.
“Clinicians should prioritize targeted testing of individuals with epidemiologic risks for TB infection or host risks for progression to TB disease, by providing LTBI testing and treatment on site to key population.” The experts observed.
Presenting on the need to diagnose LTBI in Paedriatics at the 1st Africa TB Experts Meeting hosted by Stop TB Partnership Kenya and supported by Qiagen in Nairobi, Professor Lisa Obimbo, Department Of Pediatrics University of Nairobi and Kenyatta National Hospital, said that Paedriatic T.B and Latent TB Infections acts as a future reservoir for TB disease, any successful TB control program should include a paediatrics focus.
“We need to close the tap by eliminating additional paedriatic reservoir for TB which is vital to elimination, by identifying paedriatic latent TB infections,” Prof Obimbo said.
Obimbo was speaking at the two-day meeting which brought together experts from more than 15 countries in the Africa to take stock of the progress made in the fight against TB on the continent. The experts unpacked the commitments made by Heads of State during the United Nations High-Level Meeting (UNHLM) held in New York in September.
T.B, the deadly infectious disease can affect any part of the human body although it primarily affects the lungs because it spreads easily through the air. There are two forms of TB – active and latent. The TB bacteria, Mycobacterium tuberculosis, can remain in the body without causing sickness and many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive. However, the bacteria can become active multiply and cause TB disease in people who have a weak immune system.
There are different tools and modalities available in the market today for the diagnosis and treatment of active and latent TB. TB antigen specific skin tests (TST) and interferon gamma release assays (IGRA) mean that latent TB can be detected and treated before people develop the symptoms associated with active disease.
Active TB is diagnosed with either chest X-ray, which can show irregular patches in the lungs that are typical of active TB disease, and also sputum sampling in laboratories.
Other lab tests that may be ordered include breath test, procedure to remove sputum from your lungs with a special tube, urine test, test of the fluid around the spine and brain, called cerebrospinal fluid.
Early detection, diagnosis and treatment are vital in stopping the spread of tuberculosis in Africa.
While presenting on the need to search-treat and prevent T.B,
Epidemiologist and CEO of Alcela, a healthcare delivery and technology accelerator based in Singapore Dr. Aamir Khan proposed that African countries should publicly adopt the use of IGRA technologies to help pick up asymptomatic TB before they become symptomatic arguing this approach will help in initiating TB prevention therapy (TPT) to those already tested.
Dr. Aamir said that screening at-risk people in the latent stage, when tuberculosis is asymptomatic, results in a moderate to substantial net benefit in preventing active disease.
“LTBI Testing increases uptake of TPTs and cost of testing LTBI should be reduced to increase uptake of and government should have a budget line to fund testing and treatment of LTBI,” he said.
The WHO strategy and framework towards tuberculosis elimination in high incidence countries state that LTBI screening and treatment in high-risk groups are priority actions to reach the goal of controlling and eliminating TB.
Healthcare workers representativesat the meeting stressed the need to diagnose latent Tb infection among health care workers considered at higher risk of TB disease than other populations because of their exposure. They said that health care workers have a two-to-three-fold risk for contracting TB compared with to general public.
“A high proportion 14 percent of health care workers with TB have a multi drug resistance TB (MDR TB) and there is a need to correctly identify those with LBTI and put them on TB Preventive therapies,” said a healthcare worker from Mombasa, Kenya.
He said that there is a need to create a political awareness at the higher level of Ministries of Health in order to allocate funding to health care workers LBTI program.
The co-chair of the African Parliamentary Taskforce on Disaster Risk Management (DRM) for Health who is also a Member of Parliament in Zimbabwe Daniel Molokele said that TB funding should be a key advocacy issue in Africa and the health advocates should continue making noise to ensure that TB gets the attention and allocations Covid-19 interventions was given.
Qiagen head of regional marketing for Eastern Europe, Middle East and Africa Jacqueline Karachi observed that due to the preventable nature of the disease, governments and healthcare systems must make greater efforts to strengthen prevention and awareness programs to encourage screenings and help in the timely detection of TB. Collaboration is critical in meeting this challenge head-on and, together, we can – and have a pressing responsibility to – finally end TB.
She said that the fight against TB in the continent will require collaborations between the government, the NGOs and the private sector.
“The 1StAfrican TB expert forum brings the stakeholders in TB in one room to point out their successes, more than they are pointing out their challenges because we have gone a long way as the African continent and we need to share and learn from each other in the efforts that each one of us has made,” Karachi said.
She noted that a lot of investment and emphasis should be put on TB just as the effort has been seen in the elimination of HIV and malaria, adding that unlike popular believe that TB is a disease of the poor it affects all people in the population irrespective of age and social status.
“What strong political commitment from the leadership for TB inasmuch as we are talking about HIV and malaria, we need to keep the focus also on TB,” Karachi said adding that “Qiagen offers a QuantiFERON-TB Gold Plus for latent TB diagnosis and the resolutions from such like forums will shape how government and the industry players can collaborate to ensure that diagnostics are made available for the people.”
International guidance from the World Health Organization (WHO) support the use of blood tests like QuantiFERON-TB Gold Plus in all settings as part of the fight to end the global TB epidemic.
Despite there being medical interventions for prevention of TB such the TB Preventive Therapy (TPT), most African countries are yet to roll out this intervention and its acceptance rate is low.
Stop TB Partnership Kenya National Coordinator Everlyn Kibuchi said that Kenya has intervention that can treat latent TB but has not rolled it out because it involves expensive diagnosis which is not freely available.
Dr. Deus LuKoye from Uganda said that LTBI diagnosis will help with acceptance and adherences to TPTs among confirmed household living with someone with active TB who have latent TB.
The experts recommended use of big data and modelling for cost effective analysis between IGRA and TST and targeted testing versus whole population testing.
