Fighting TB through Universal Health Coverage in COVID-19 era

Tuberculosis (TB) is a contagious but curable and preventable disease caused by Mycobacterium tuberculosis and it attacks the lungs (pulmonary TB). It also affects other bodily organs (extra pulmonary TB).

Pulmonary TB is transmitted from a sick TB patient to another person as a droplet infection through coughing, singing and sneezing. All age groups and societies are susceptible to TB.

The national incidence rate for TB in Ghana is about 144 per 100, 000 population by the end of 2019. In 2003 (57 years after its first survey), Ghana conducted a second TB prevalence survey nationwide and found an estimated national TB prevalence of 290 per 100,000 population.

Suffice to say that the TB disease burden was about four times higher in 2003 than the World Health Organisation (WHO) estimates for the same year (71 per 100,000 population).

Petrified global killer

Alarmingly, TB is one of the petrified top 10 causes of death globally and according to the WHO, about 1.4 million people die of TB each year across the globe.

Inferably, TB is a top killer worldwide, ranking alongside HIV/AIDS. Sadly, TB places its heaviest burden on the world’s most poor and vulnerable and this aggravates existing inequalities. The fight against TB must be intensified through Universal Health Coverage (UHC) especially during the COVID-19 pandemic.

TB and UHC

The United Nation’s Tokyo Declaration in 2017 adopted the UHC in 2017 to reduce barriers to accessing quality health services globally.

Accordingly, the UHC concept requires that all people should be able to have an equitable access to quality health services devoid of financial, geographical, social and other barriers.

The 3rd and 8th targets of the third Sustainable Development Goal Three (SDG3) refer respectively to TB eradication and achieving UHC by 2030.

Fighting TB through UHC in the era of COVID-19 means that the health sector must provide UHC-focused services that are affordable, appropriate, accessible and tailored to eradicating TB.

Accordingly, SDG3.3 hinges on the strategic fight against TB on three pillars namely:

1. Integrated, people-centered care and prevention of TB.

2. Bold policies and supportive systems that ensure UHC, social protection, poverty alleviation and action on the social determinants of TB.

3. Intensified research and innovation regarding TB and HIV.

TB and COVID-19

My foreboding is that if care is not taken, the current global focus on COVID-19 will deviate most countries, including Ghana, from the fight against TB. This will happen if TB cases are symptomatically picked and treated as COVID-19 cases.

This is because even though TB and COVID-19 are two different infectious respiratory diseases, both diseases share certain constitutional symptoms such as cough, fever, shortness of breath, fatigue and loss of appetite.

Advisedly, therefore, patients who exhibit the common symptoms of TB and COVID-19 must be tested for both conditions to facilitate the most appropriate and targeted treatment regime. To my mind, this is the only way by which Ghana, and for that matter, the world will not be misled to diagnose TB cases as COVID-19.

Apart from COVID-19, TB is equally linked to HIV/AIDS. Globally and in Ghana, TB is the most common opportunistic infection with a high mortality rate among HIV-infected individuals. In fact, out of about 1.5 million people who died from TB in 2020, about 214,000 of them were people with HIV/AIDS.

Funding

The Global Fund provides for free diagnosis and treatment for TB in Ghana through the National Tuberculosis Control Programme (NTCP).

Accordingly, the NTCP provides TB diagnostic equipment and medications to various public health facilities nationwide.

Despite this progressive effort in fighting TB in Ghana, the stark reality is that some TB patients are unable to easily access sustained treatment leading to significant defaulter rates.

This is because some of these patients do not have reliable sources of income and so they are unable to regularly afford the cost of transportation to and from health facilities providing TB treatment.

In some cases, the TB treatment centres are geographically inaccessible to significant other persons living with the disease.

Some of these barriers to early detection and sustained TB treatment lead to Multidrug - resistant TB (MDR-TB).

The MDR-TB occurs when the TB bacteria does not respond to treatment due to incorrect prescriptions by healthcare providers, poor quality drugs and patients stopping treatment prematurely.

In the past, the Global Fund was providing financial support that took care of the transportation needs of the TB patients but in recent times, that support is only meant for MDR-TB patients.

Recommendations

Achieving the SDG targets on TB and UHC require multipronged approaches to overcome the disease in the era of COVID-19 because it will help to attain higher treatment success for all forms of TB.

The COVID-19 pandemic must not deviate us from our sustained fight against TB. Accordingly, patients who present with common symptoms of COVID-19 and TB must be tested for the two diseases before a treatment regime is prescribed.

Making TB treatment universally accessible to even hard-to-reach people in the country, through the implementation of the UHC requires that the government must make TB diagnostic services and treatment accessible to every part of the country.

In this regard, special purpose vehicles may be procured to serve as mobile TB clinics that intensify early case detection of TB and bringing TB to the door steps of the people, especially the vulnerable in the society.

The writer is a Health Service Administrator and Columnist
Email: afetikorto@yahoo.com