Tuberculosis (TB) And Poverty: Partners By Default
There is a direct link between TB and poverty. It is indeed a vicious cycle, as one begets the other. The stark reality is that tuberculosis saps the economy of the community, which in turn increases the likelihood of contracting TB. This point emerged several times during the recently concluded Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients, which took place in Addis Ababa, Ethiopia. The meet was organized by TB Alliance with support from the Bill and Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group among others.
The economic impact of tuberculosis 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 upon the importance of improving the quality of health care systems. He said that tuberculosis is indeed a disease of the poor. He agreed that some life style changes may trigger off the disease. Yet most of it occurs in non smokers and non diabetics. He said that there was evidence that every time after an economic downturn, TB incidence worsens.
The side effects of TB medicines are devastating, more so in the case of MDR TB, or in those suffering from TB and HIV. Poverty results in severe malnutrition, as patients cannot afford a proper, nutritious diet. This further increases the chances of co infection. A healthy diet and properly ventilated living spaces are very important in management of the disease.
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 lamented 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."
Francis pleaded for the need of new TB drugs, which can rapidly kill the TB bacilli with fewer side effects and which are also compatible with ARVs. He appealed to the fund managers, researchers, drug manufacturers and regulators to help speed up this process
There is an urgent need for more robust drugs to address the challenges and unmet needs in TB therapy. According to Dr Brian Woodfall, head of the Medical Department at Tibotec, successful drug development is not achieved till new cures reach the affected communities. Such a drug should comply with the four As--- Affordability, Adoption, Availability, and Appropriate use.
So, in the words of Francis Apina, "We need a game changer in new TB drugs development like never before. For people living with HIV and their families, the search for new TB drugs - especially those that can be taken with anti retroviral drugs—is a race against time."
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.
This is exactly what organizations like the TB Alliance and its partners are striving for. Thanks to the untiring efforts of several agencies, today the global portfolio includes 9 new TB drugs in clinical stages of development, three of which are part of the TB Alliance's portfolio.
There are still miles to go before we can rest and sleep. But well begun is half done. The time has come for novel TB regimens to be realistically conceived and accomplished. We all hope that CPTR will make a positive difference in the lives of millions of TB patients all over the world.
Citizen News Service (CNS)