We Must Innovate To Find The 40% Missing People with Tuberculosis

We all want to lead a healthy life and stay physically and mentally strong. Achieving this requires us to seek services from healthcare facilities. However, because of poor health-seeking behaviour, one of the major causes of ill health and death globally is Tuberculosis (TB), which can be traced back 9,000 years ago in Atlit Yam, a city now under the Mediterranean Sea, off the coast of Israel. This disease was the leading cause of death from a single infectious agent until the COVID-19 pandemic, despite being preventable and curable. The majority of people with TB symptoms do not seek care because of the assumption that their symptoms are not severe enough to require medical attention.

Globally, each day over 4,100 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. According to WHO, the number of people newly diagnosed with TB and those reported to national governments was 5.8 million in 2020. WHO also estimates that some 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported to national authorities.  Covid-19 has reversed years of progress in providing essential TB services and reducing TB disease.

Kenya is classified as a high burden country for TB and TB/HIV (WHO Global TB Report 2021). TB is the 4th leading cause of death in Kenya. The National TB Prevalence Survey (2016) found that about half of the country’s estimated people with TB are currently missed by public health services. Research has shown that any person who is ill with TB and not yet on treatment can infect between 10 and 15 people in close contact within a year, posing a big challenge in TB control. While there exists a strategy of linking the community to the health system in Kenya, there are a number of gaps limiting the effectiveness of TB case finding interventions at the community level.

The theme of 2022 World TB Day is “Invest to end the epidemic”.  Investing in innovations to find missing TB cases is critical in ending this epidemic. Through Global Fund support, Kenya redesigned its TB control strategies to incorporate innovations from civil society organizations in order to find undiagnosed TB cases. The innovations are implemented under the Kenya Innovation Challenge TB Fund (KIC-TB) through Amref Health Africa in Kenya in collaboration with its partners and the Ministry of Health. Through the support of the Global Fund and other partners, Amref Health Africa in Kenya has achieved great success in contributing to the reduction of TB prevalence in Kenya.

KIC-TB has provided an excellent opportunity for organizations and groups working with communities to show how innovative and impactful they can be in the national fight against TB. Emphasis is on finding missing TB Cases using innovative strategies unique to the local settings. The objective is to find missing TB cases using innovative strategies unique to the local settings, accelerate case finding and scale-up tools and approaches that have worked well.

Eleven innovations were implemented in 2019. Some of the innovations include children leading the fight against TB through screening themselves and household members. Through this innovation, children will carry TB knowledge into their adult life and households thereby transforming the entire community. Another innovation engages inmates in prison, staff and their families to screen for TB. Others include finding missing people with TB among mobile populations, self-screen for TB using an Automated TB screening Machine (ATSM) which is similar to the Automated Teller Machine stationed at high traffic areas including huduma centres, railway terminus and passport control centres in Nairobi County and TB screening in the matatu industry that targets men in the public transport sector (drivers, conductors, touts).

These innovations are key in finding missing people with TB among key populations and communities. However, they have gaps that must be identified at the earliest opportunity and appropriate strategies put in place to address them. We should encourage innovative ideas in our public health programming, particularly for the key populations and the underserved. These ideas should be mainstreamed in routine programming with clear national level indicators to ensure that they are resourced. Civil society must not tire in their role to undertake evidence-informed advocacy to ensure that policymakers proactively dedicate and allocate resources, domestic and from donors, to end TB. With strategic innovations, solidarity, determination and equitable use of resources we will end TB. Let us embrace innovations.

Article first published on https://nation.africa/kenya/blogs-opinion/blogs/innovate-find-40pc-missing-people-with-tb-3758028