DOH eyes TB elimination by 2022


But rapid increase in drug-resistant TB infections, deaths presents growing challenge

THE Department of Health (DOH) announced an ambitious strategy to move from “control” to “elimination” of tuberculosis in the Philippines in commemoration of World Tuberculosis Day on Friday last week but new research published the same day by doctors in South Africa warned that “new antibiotics that could treat tuberculosis may rapidly become ineffective,” in part because of widespread misuse of medications in countries where TB is prevalent.

Health Secretary Paulyn Jean Ubial, in a World Tuberculosis Day event at the Quezon Institute compound in Quezon City (Metro Manila), called for concerted action to fight TB, noting that despite the country’s progress in addressing the deadly infection, it remains the eighth leading cause of death in the Philippines, according to the 2016 Philippine Health Statistics.

Ubial said in a news briefing that this year marks a shift in the Philippines’ strategy from focusing on TB control to virtual elimination of the disease, using stronger measures to reduce tuberculosis (TB) to the status of a rare disease by 2022.

The initiative is detailed in the 2017-2022 Philippine Strategic TB Elimination Plan 1, also known as PhilSTEP 1. The objective of the plan is to reduce TB incidence in the country to three cases per 10,000 population, Ubial explained.

In order to more accurately identify TB cases, Ubial said the DOH will use new diagnostic technology. Current methods to detect the disease are through sputum microscopy and X-ray, which is sometimes unreliable. But now, the DOH utilizes the gene expert method, which uses genomics or genetic sequencing to detect TB bacilli, she said.

DOH information on tuberculosis indicated that the people at highest risk for contracting the disease are jail inmates, children, urban poor, those with diabetes, and those infected with HIV or suffering from AIDS.

Growing drug resistance

Despite the DOH’s optimism, a new study by researchers in South Africa and published on World Tuberculosis Day by the prestigious British medical journal The Lancet suggested that determination may not be enough to slow the spread of the disease, due to the growing number of cases of drug-resistant TB being recorded.

The study found that 480,000 people worldwide were afflicted with some form drug-resistant TB in 2015, which represented a ten-fold increase in cases over the past decade. According to World Health Organization (WHO) data, the number of people affected by extensively multi-drug resistant (XDR) TB, the most dangerous type of TB infection because it is essentially untreatable, increased to 132,000 in 2015 from 122,000 in 2014.

Both drug resistant and non-drug resistant TB killed an estimated 1.8 million people in 2015, making it the world’s deadliest infectious disease. The five countries where TB is most prevalent are India, Indonesia, China, Nigeria, Pakistan and South Africa.

The inappropriate use of antibiotics, including taking them without prescription or not following doctor’s orders closely, is slowly rendering many antibiotics useless. The study noted the problem is most serious in developing countries where patients often cannot afford treatment or do not have adequate access to healthcare.

“Resistance to anti-tuberculosis drugs is a global problem that threatens to derail efforts to eradicate the disease,” said lead author of The Lancet report Professor Keertan Dheda from the University of Cape Town, South Africa.

Even when the drugs work, TB is difficult to cure and requires months of treatment with a cocktail of drugs. When resistance occurs the treatment can take years and the drugs used have unpleasant and sometimes serious side effects, said Dheda.

Lack of access to drugs

For now, there are some medicines that can be used to treat drug-resistant TB, but according to the Medecins Sans Frontieres (MSF) Access Campaign, fewer than five percent of the people with the infection have access to them.

“Our first major problem is that pharmaceutical corporations are not even registering important new drugs in some of the countries hardest hit by TB; The next major problem is their high price,” said Dr. Isaac Chikwanha, TB advisor for MSF’s Access Campaign.

People with drug resistant TB who don’t have access to the two new drugs continue to be treated with older, more toxic regimens that cure only 50 percent of people treated and cause severe side effects ranging from severe nausea to deafness to psychosis said MSF Access.

WHO Director General Dr. Margaret Chan recently announced there are two high-level conferences planned, one this year and one in 2018 to “shine a light on TB” and give it “the political attention and the investment in research and development that it deserves.”

There is no denying the fact that TB is a top priority for the world, she said.

But both The Lancet study and MSF Access stressed that research and development alone, though needed, is not enough to address the shortcomings in the global response to TB and anti-microbial resistance without a matching political response.



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