Tuberculosis And Poverty: Partners By Default
There is a direct link between tuberculosis (TB) and poverty. It is indeed a vicious cycle, as one begets the other. The stark reality is that TB saps the economy of the community, which in turn increases the likelihood of contracting TB. This point emerged several times at two important meetings in past 2-3 months: Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients, Ethiopia, and the consultative workshop of the TB and poverty sub-working group in India (29-30 October 2010). Before the 41st Union World Conference on Lung Health opens in Berlin, Germany, the point is made clear: the economic impact of TB is staggering.
It is estimated to rob the world’s poorest countries of an estimated USD 1 to USD 3 trillion over the next 10 years. 94% of the TB cases and 98% of TB deaths occur in developing countries – and often amongst the poorest in those countries. Also, a large majority of TB patients belong to the age group of 15-54 years, which are the most productive years of one’s life.
The WHO estimates that the average TB patient loses 3 to 4 months of work time and up to 30% of family earnings per year. Entire economies are affected. The burgeoning cost of TB medical care further compounds the problem, putting a constant drain on resource-depleted health systems.
Dr Jeremiah Chakaya, who heads the DOTS Expansion Working Group of the Stop TB Partnership, echoed similar sentiments saying that a partial solution to controlling and preventing TB is to reduce poverty. Economic self sufficiency almost invariably results in healthier diets and better living conditions, which in turn increases the resistance of the body and improves the immune system.
So, a faster and better cure could provide immediate benefits. A shorter drug regimen would reduce lost work time and decrease the economic burden on the patient and the family. Fewer visits to the doctor would ease the burden on tottering health systems, and funds could be redirected to basic health care and TB control programmes.
Simpler diagnostic and treatment tools will result in savings and make the healthcare systems more efficient. Dr Mel Spigelman, MD, CEO of the TB Alliance stressed that there was evidence that every time after an economic downturn, TB incidence worsens.
Barriers to adherence of the drug regimen are socioeconomic. Francis George Apina, a TB/HIV Advocacy Manager and a patient representative from Kenya, voiced the sentiments of many when he said that "TB deprives families/communities, resulting in increased poverty and a sense of hopelessness. The long length of treatment, the severe side effects, and the far away location of the nearest health centre very often result in the patient discontinuing treatment and becoming more prone to MDR/XDR TB which is more costly to treat. An over burdened health system cannot deal with these socio economic problems. So the patients are sent back home—to infect more people in the process."
Thus future regimens for TB treatment should be more patient friendly, by being cheaper, safer and by drastically reducing treatment time. A faster and simpler cure for TB will save lives and have tremendous global benefits. It would improve treatment compliance (thus preventing the emergence of the deadlier drug resistant strains) and allow more patients to be treated.
Shobha Shukla - CNS