Tuberculosis

The World Health Organization (WHO) estimates that some 10 million people — including 1 million children between the ages of 0 and 14 — were infected with Mycobacterium tuberculosis in 2017 and 1.6 million individuals died from tuberculosis (TB). Alarmingly, only 6.4 million of these people were detected and notified, which means 3.6 million individuals did not get the treatment they needed. This is a gap that must be closed if we are to meet the Sustainable Development Goal (SDG) of ending the TB epidemic by 2030.

Although TB is both curable and preventable, globally it is the leading cause of death from a single infectious agent and the leading cause of death among people living with HIV. In fact, as many as two-thirds of all people who develop active TB will succumb to the illness. TB occurs in every part of the world, but as with many infections diseases, low- and middle-income countries are disproportionately affected, with more than 95 percent of those who contract the disease living in these nations. Some 80 percent of all TB cases occur in 30 high-burden countries, with two-thirds of those concentrated in just eight countries in Asia (6) and sub-Saharan Africa (2).

Most standard TB treatments have been around for decades, but during the past 10 years resistant strains of the bacteria have evolved largely due to incorrect or inappropriate use of these medicines. Of the 558,000 resistant cases diagnosed in 2017, 82 percent were multidrug-resistant tuberculosis (MDR-TB), which makes extensively drug-resistant TB (XDR-TB) an increasing concern worldwide.

As the prime implementer of WHO/Europe’s Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia, AIHA worked with renowned international and regional experts to develop a series of training courses focused on training health and allied workers to provide care for people co-infected with HIV and TB that stresses regular clinical and laboratory monitoring, tuberculosis screening, cotrimoxazole prophylaxis, and evidence-based interventions that foster patient retention and adherence to treatment — four “universal interventions” identified by PEPFAR as having the greatest impact on HIV-related morbidity and mortality, according to an article published in the April 15, 2015 issue of the Journal of Acquired Immune Deficiency Syndromes.

AIHA carried out similar curriculum and faculty development work under the aegis of the USAID-supported Strategic Health Partnership Initiative with the Russian Ministry of Health and several leading postgraduate medical institutions in Russia and elsewhere in Eastern Europe and Central Asia.

Through our HRSA-supported HIV/AIDS Twinning Center Program, a number of partner institutions that provide clinical care for PLHIV in sub-Saharan Africa have integrated TB screening, education, and treatment into their standard care. 

Selected Program Results

• In close collaboration with local and international stakeholders, AIHA spearheaded the establishment of Moldova’s national TB laboratory network, renovating four reference laboratories, revising guidelines on methods, and instituting quality control and feedback procedures.
• One of the most significant outcomes of improved laboratory capability was the approval by WHO’s Green Light Committee (February 2005) of DOTS-Plus for MDR-TB treatment in Moldova.
• Developed curricula and related professional education materials and used them to train 898 Moldovan physicians and 1,204 nurses working in primary care how to better diagnose, treat, and prevent tuberculosis.
• Helped advance Moldova toward the global target of TB case detection at a rate of 70 percent of infectious pulmonary TB from a pre-project low of 46 percent to 65 percent by 2005 (the latest year for which data was available).
• Developed a series of graduate and undergraduate courses on TB and TB-HIV co-infection in close cooperation with leading Russian medical institutions and conducted related training-of-trainers workshops for HIV and TB experts from 10 countries spanning Eurasia; more than 15 Russian universities have confirmed integration of these courses into their standard curricula and AIHA worked with leading medical institutions of Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, and Uzbekistan to adapt these courses and translate them into local languages and disseminate them.
• Developed a distance learning course on “Issues of Specialized Medical Care for HIV/TB Co-infection” jointly with faculty from the I.I. Mechnikov North Western Medical University (formerly known as the St. Petersburg Medical Academy for Postgraduate Studies), which was approved for national use by Russia’s Educational and Methodological Board in April 2012.
• Deployed Russian laboratory experts for short-term mentorship assignments in 2009-2011, including three experts who provided technical assistance on HIV, TB, and mycology lab diagnostics in Botswana.
• Oversaw extensive renovations done at four Reference Laboratories in Moldova, which vastly improved national capacity to diagnose and monitor TB. The renovations also greatly improved safety conditions for technicians and clinicians working in these labs.
• Worked with key stakeholders to design an effective TB surveillance system, which also integrated monitoring and surveillance of all infectious diseases on a common platform. The new system provides linked information, making it much easier to analyze trends and adjust strategies for stemming the spread of TB and other infections.
• Through our PEPFAR-supported HIV Treatment, Care, and Support Project in Russia, US experts provided a wealth of technical assistance to improve the quality and scope of health services available to people co-infected with TB and HIV, including those who also faced substance abuse and addiction issues.
• Improved treatment for PLHIV in Ethiopia and Mozambique through the integration of TB prevention, screening, and treatment at Debre Berhan Hospital in Ethiopia and St. Luke’s Health Center in Beira, Mozambique.
• From 2007-2010, AIHA supported a partnership between University of the Free State’s Centre for Health Systems Research and Development and the State University of New York Downstate Medical Center, which strengthened the Centre’s ability to collect, analyze, and report scientific data on HIV and TB infections in South Africa‘s Free State to better inform policy and practices in the province and throughout the country.