World Tuberculosis Day: Dissecting FG, Partners’ Efforts To Eradicate Disease
THE Federal Government through The Global Fund grant has intensified its commitment to end HIV/ TB in the country through the procurement of diagnostic equipment and HIV/ TB supervision vehicles. However, experts believe that inadequate manpower and insecurity could pose as hindrances to these tangible efforts.
Regardless of the preventive and curable nature of Tuberculosis ( TB), the disease remains a global burden and one of the world’s deadliest infectious killers with approximately 1.3 million deaths each year. Its adverse effects continue to broaden on individuals, families, communities and the society at large.
According to the World Health Organisation ( WHO), each day, close to 3,560 people lose their lives to TB and about 30,000 people fall ill with this preventable and curable disease with approximately 1.3 million deaths caused by TB in 2022 alone.
Following the commitment made by Heads of State at the United Nations ( UN) High Level meeting in 2023 to accelerate progress to end TB, more people have been cured of the disease and it is estimated that efforts to combat TB have saved about 75 million lives since the year 2000 with a significant worldwide recovery in the scale- up of TB diagnosis and treatment services.
Nigeria is no exception to this deadly disease and according to experts at The Global Fund, Nigeria currently has the highest number of TB cases in Africa with over 350,000 notified case findings in 2023 and increase in the absolute number of DrugResistant Tuberculosis ( DR- TB) cases from 2,897 in 2021 to 3,932 in 2022.
Despite significant progress being made in expanding TB services to both public and private health facilities in the country, childhood TB cases are still suboptimal with only seven per cent of the cases notified in 2022 falling short of the projected 15 per cent.
The equipment, including vehicles and diagnostic machines, which were procured through Global Fund and recently unveiled by the Federal Government, estimated to worth over 56 million dollars, are aimed at increasing case finding coverage, care and supervision of cases for persons with HIV/ TB in Nigeria.
In an interview, the technical Director, Global Fund HIV programme, Dr. Emeka Anoje, emphasised on manpower shortage in the country and how the upsurge in the migration of the health workforce has worsened the situation in the country especially post COVID- 19.
He said: “We witnessed evidence of the effect of a shortage of health workforce but unfortunately, whatever pre- COVID- 19 situation we had has even worsened given the deluge of migration of health workforce to developing countries and that’s still a major problem.
“Recruitment into public institutions, not just the hospitals but most public institutions has been stifled in a lot of states for some time. It’s only recently that there has been a pronouncement about lifting the embargo on recruitments and hopefully that would replace some of the positions that were lost but significant shortages still exist in terms of manpower.”
He added that the insecurity in the country could also pose a huge challenge as some remote areas might not get adequate access to diagnosis, care and inspection.
“And then of course we are all witnesses to the insecurity situation in the country particularly affecting rural areas and hard to reach areas. This has the potential and may
already be affecting access to health care as some people may not be willing to visit hospitals in those areas. And health care workers who work in those areas may not be very comfortable coming to work as well and that may have also further fueled the healthcare worker shortages and crisis in those areas. Lastly, there is a need to improve our health service delivery integration within the country,” he said.
Anoje pointed out the importance of vaccination and how a lot of people who need it are still unable to access it.
“The starting point to an effective response against TB is by preventing its occurrence in the first place. Unlike HIV where the potential prospect of a vaccine is still many years from now, the TB vaccine, which is given to infants, is the single most important step in reducing the incidence of TB amongst a given population. In order to achieve that, it is important that every child, individual is immunised against TB.
“Even with the progress in recent times and the vaccination coverage of the BCG vaccine from 2020 to 2021 having about 68 per cent coverage in the country, the coverage varies from state to state; some states report coverage as high as 99 per cent especially states in the Southeast like Enugu, which reported 99 per cent coverage. Some other states are not doing so well, with records of about 38 per cent like Kano. The coverage has come up to 74 per cent in 2022 but there is still a lot that needs to be done because one quarter of children that need to be vaccinated against TB are not receiving it,” he said.
According to a progress report on TB cases in Nigeria made available to The Guardian by The Global Fund, it has invested over 4.8 billion dollars in the country since 2002, including 1.2 billion dollars in the previous cycle, and the new grants that were recently launched to reinforce progress against HIV, TB and malaria. The report indicated that Nigeria is The Global Fund’s largest investment portfolio.
In the report, Disease Fund Manager, TB/ HIV for Nigeria, Margaret Zamzu, explained the TB programme performance and treatment coverage over the years and how The Global Fund redesigned grants and implementation arrangements have impacted the country’s fight to end TB greatly.
“Prior to 2019, the Nigeria TB programme performance had been static for over a decade with treatment coverage consistently below 24 per cent. However, with the redesign of our grants and implementation arrangements, Nigeria has steadily increased case finding efforts with TB notification tripling since 2018, when 106,533 TB cases were notified compared to over 350,000 in 2023,” she said.
Zamzu continued: “Significant progress has also been made in expanding TB services to both public and private health facilities. This has been a key strategy to increase accessibility to TB services and has contributed to reducing indirect cost incurred by TB patients and their households.”
She emphasised that the focus is to find and treat all people with drug- susceptible and DR- TB while accelerating the progress towards ending TB. Zamzu also pointed out that the newly signed grant worth 993 million dollars to support the fight against TB, AIDS and malaria while strengthening health systems and pandemic preparedness in the country, would largely be used to address gaps in human rights, gender and health inequities.
“Interventions to reach those who are left behind in addition to interventions to tackle the root causes of violence and stigma and discrimination will be undertaken in the new grants. Of the eight new grants ( US$ 993 million), over US$ 146 million ( 15.6% of the total allocation) are allocated to the fight
against TB in the country,” she added.
On TB gender prevalence in Nigeria, Senior TB Advisor at the Global Fund, Dr. Mohammed Yassin, said that there is 58 per cent more prevalence in men than women in Nigeria; therefore men are slightly more susceptible to contracting TB and this could be due to a number of reasons like occupation, living conditions, behavioural patterns, healthcare access and biological differences.
“While women generally face greater barriers to TB care, men are globally more likely than women to have active TB. Harmful gender norms around masculinity may also lead to greater exposure to risk factors for men, like smoking and working in high- risk occupations, as well as a lower likelihood to seek care,” he said.
According to Yassin, deaths from DR- TB account for about one- third of all antimicrobial resistance ( AMR) deaths worldwide. Although people with serious disease may die during treatment or interrupt treatment due to different reasons including drug adverse effects, the reasons behind the development of drug resistance in TB are diverse.
“Insufficient healthcare infrastructure can hinder effective TB management. Inadequate monitoring, follow- up and patient education may lead to non- adherence. Patients who miss doses or fail to adhere to treatment schedules are at risk of developing resistance.
“Within an individual patient, TB bacteria can evolve resistance over time. This occurs due to genetic mutations that confer resistance. Factors like bacterial metabolic processes, drug tolerance and mutagenesis contribute to this evolution,” he said.
Drug- resistant TB occurs when bacteria become resistant to the drugs used to treat TB; therefore the drug can no longer kill the TB bacteria. DR- TB is spread the same way that drug- susceptible TB is spread.
Ahead of this year’s World Tuberculosis Day themed, ‘ Yes! We can end TB!’ WHO urges increased investments to scale up TB screening and preventive treatment, shifting this year’s focus to tangible actions.
WHO has recommended that high level leadership, increased sustainable investments of resources, support, care and information would accelerate progress to help countries scale- up access to TB preventive treatment, TB care and research and ultimately end TB.
While women generally face greater barriers to TB care, men are globally more likely than women to have active TB. Harmful gender norms around masculinity may also lead to greater exposure to risk factors for men, like smoking and working in high- risk occupations, as well as a lower likelihood to seek care.