Prevalent and Transmissible

Nutsa Shubashvili, TV3

 Prevalent and Transmissible

 “As new threats like Ebola rightly command concern and attention, we need to remind political leaders that TB still accounts for 1.5 million lives every year, which means that every day it kills as many people as Ebola has in total,“ these words belongs to Nick Herbert MP, co-chairman of the UK’s All Party Parliamentary Group on Tuberculosis. Parliamentarians and political leaders from 5 continents signed the Barcelona Declaration on Tuberculosis (TB) by the end of October 2014. The declaration was the result of the inaugural Global TB Summit, which was held in conjunction with the 45th Union World Conference on Lung Health in Barcelona from 28 October to 1 November. By signing the Declaration politicians committed to work together in the fight against TB. The Declaration also outlines that new TB drugs, diagnostics and vaccines are desperately needed. Politicians have agreed that challenges like co-infection with HIV and a looming co-epidemic of TB and diabetes still remain as an unresolved problem.

45th Union World Conference on Lung Health, Barcelona, Spain, organised by the International Union Against Tuberculosis and Lung Disease. Opening Ceremony of the Conference. Photo©Marcus Rose/The Union

The fears of officials are supported with the report – The Looming Co-epidemic of TB-Diabetes: A Call to Action, which was released on the opening day of the 45th Union World Conference on Lung Health. The International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation call in their report for international action against a looming co-epidemic of diabetes and tuberculosis. Unfortunately, there are not some promising figures. Diabetes triples the risk that a person will develop tuberculosis. It means that if a person is TB infected and develops diabetes, he\she has a 30 percent lifetime risk of TB. Moreover, it is expected that cases with diabetes will increase from 382 million in 2013 to 592 in 2035. According to the World Health Organization (WHO) TB infected 9 million people worldwide in 2013, 1.5 million people died in 2013 – more deaths from TB last year than any year in history.

Of the 9 million people sickened with TB each year, 3 million don’t get the care they need. So there are many patients who do not receive adequate treatment and enough attention. Due to this and the fact that some TB patients stop taking medicines develops severe forms of TB, like MDR-TB – Multi-Drug-Resistant TB, what means that tuberculosis is resistant to at least isoniazid and rifampicin, two of the most important first-line drugs typically used to treat TB. According to the World Health Organization, an estimated 480,000 people developed MDR-TB and nearly 210,000 died from the disease in 2013. About a third of those are in three nations: 62,000 in India; 54,000 in China; and 41,000 in Russia. The cure rate for MDR-TB is 50 percent – which is the same as Ebola, although the numbers are significantly higher for MDR-TB than Ebola.

45th Union World Conference on Lung Health, Barcelona, Spain, organised by the International Union Against Tuberculosis and Lung Disease. Photo shows a delegate's pin badge at What should we Fight For? Building a Unified TB Advocacy Movement. Photo©Marcus Rose/The Union

At the 45th World Conference on Lung Health were also presented the preliminary results of two new studies, which show that a nine-month treatment regiment for MDR-TB appears to be as effective as a twelve-month regimen. The study was coordinated by The International Union Against Tuberculosis and Lung Disease and conducted in nine African countries. Data were presented on preliminary treatment outcomes for 208 patients who had completed four months of treatment. “These preliminary results from observational studies are a promising indication that a shortened treatment option for patients with multidrug-resistant TB is within reach,” said I.D. Rusen, Senior Vice President for Research and Development of The Union. “Treatment for MDR-TB is one of the most grueling experiences for both patients and healthcare workers alike. Our hope is that a shorter treatment option will lead to higher rates of treatment success.”

TB prevalence worldwide per 100,000 is 125 cases and 32 cases in Europe. This figure In Georgia was 96 in 2013 and Georgia is one among 27 high MDR-TB burden countries. In our country works the National TB program and within it there are many instruments to fight against the disease. All the diagnostics and treatment are free for every patient. There are centers for both ambulatory and stationary treatments, where the environment and accommodation is accessible and appropriate. Also, there is a new program for patients who suffer from severe forms of TB in order to make the treatment process less burdensome.

But still there are many issues that need to be improved. “One of the main problems is an interrupted treatment, when a patient refuses to take a medicine. Some of them just do not have enough responsibility and do not realize that they can spread the disease through the air and infect other people,” said Zaza Avaliani, executive director of the National Center for Tuberculosis and Lung diseases. The rate of interrupted treatment in 2013 was 38 percent, and it is a really dangerous statistics because it is proved that one person with TB can infect up to 15 more people. “In the society there is still a strong stigma related to TB, people avoid talking about their disease. Sometimes they lose their jobs, become antisocial. Another problem is late applies when the disease is at a high rate and you cannot help them anymore. The main reason of this is that people do not have enough information how dangerous TB is,” added professor Avaliani.

45th Union World Conference on Lung Health, Barcelona, Spain, organised by the International Union Against Tuberculosis and Lung Disease. A woman looking at the photo exhibition which shows the people who has defeated tuberculosis Photo©Steve Forrest/The Union

It is well-known that all overcrowded places raise the risk of TB infection. Of course penitentiary system in Georgia is no exception. However, in the past two years the number of infected people has dropped and the occurrence of new cases in prisons has been reduced. In prisons currently operates the system of monitoring and control in respect of administration and prevention of the desease; all prisoners have access to free medical treatment. Another problem occurs when TB is co-infected with HIV or diabetes. WHO recommends that TB patients were screened for diabetes and DM patients screened for active TB. The same must be done in case of TB/HIV, that is already done in Georgia. Despite this fact in 2013 we had 2.1 percent of co-infection TB/HIV.

In Georgia some new generation medicines like Bedaquiline and Delamanid are already being used. These drugs are cheaper and may decrease the treatment period to as short as nine months, in combination with older drugs. In general, treatment success rate in Georgia for TB is more than 50 percent, but as Zaza Avaliani explains there are some unidentified cases which remain undiagnosed. So, there are some TB cases beyond official statistics. Considering all the circumstances it is a step forward that in recent year the funding of the National TB program has increased up to 12 million Lari.

In early November the Union announced plans for new clinical research that will evaluate the effectiveness of two new treatment regimens for multidrug-resistant tuberculosis (MDR-TB). The two regimens to be tested include an all-oral nine-month regimen and a six-month regimen. The current standard treatment regimen for MDR-TB lasts up to 24 months and requires frequent injections. The Union hopes that if these new regimens prove tobe effective, the research will help make MDR-TB treatment substantially less burdensome for patients and health systems. Results of the study are expected in 2020. It is definitely a new hope for everyone who suffers from TB because the treatment usually damages an organism as well as psychics.

But the approaches of the parliamentarians are not less promising. “…Every patient, regardless of who they are, where they live, or their ability to pay, shall have access to quick, accurate diagnosis and high quality treatment, and that TB diagnosis and treatment never result in the impoverishment of patients or their families,” says one of the point of the declaration on TB that parliamentarians and political leaders have issued at the 45th Union World Conference on Lung Health in Barcelona.

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