Step Up for TB 2020 Report

Step Up for TB 2020 Report | UPSC

      HEADLINES:

New survey finds millions of people affected by TB still diagnosed and treated with outdated tools

      WHY IN NEWS:

Data on 37 countries reveals widespread failure to follow latest international recommendations for policies on prevention, diagnosis, and treatment

SYLLABUS COVERED: GS 3:Reports

      LEARNING: 

For PRELIMS note down the medicines and treatment for TB . Go through the WHO Guidelines once and revise them tonight again.

For MAINS collect few points for not achieving 2022 UN target (global elimination of TB).

      ISSUE: 

With an estimated 7.7 million people developing TB each year, these 37 surveyed countries represent 77% of the global TB burden.

STEP UP FOR TB 2020 REPORT

OVERVIEW

  • The report reveals both progress and shortcomings in the alignment of national tuberculosis (TB) policies with the latest international recommendations.

The report finds that significant policy gaps risk undermining progress in the fight against TB.

  • Step Up for TB 2020 examines the national policies of 37 countries with a high burden of TB.
  • Meanwhile, TB remains the top infectious disease killer, even though it is preventable and curable.

TITLE

  • Step Up for TB 2020 -Tuberculosis Policies in 37 Countries , A survey of prevention, testing, and treatment policies and practices

PUBLISHED BY

  • Médecins Sans Frontières (MSF) , Geneva, Switzerland.
  • It is an independent international medical humanitarian organisation .

The organisation delivers medical care to people affected by armed conflicts, epidemics, natural disasters and exclusion from healthcare. 

  • It was founded in 1971, MSF has operations in over 70 countries.

KEY HIGHLIGHTS

  • The report finds that many of the surveyed countries still have outdated testing policies that may lead to inadequate TB prevention and care.

Around 347,000 people who develop TB each year in the 37 surveyed countries have a form of drug-resistant TB.

  • Of them, only 1% can hope to access comprehensive universal drug sensitivity tests.
  • Just six of the 37 countries (18%) have introduced the necessary policies.

TB is the most common cause of death among people living with HIV, more than 28 million of whom live in the 37 surveyed countries.

  • 80% of surveyed countries indicate that they are now able to use rapid molecular TB tests as the initial test.

UN TARGET
With just two years until the 2022 deadline for the UN TB targets, urgent investment is required to get global efforts back on track.

  • India is still following a very conservative approach regarding the new medicines for drug resistant TB, putting lives of patients including children in danger.

REPORT ANALYSIS

To meet the commitments of the UNHLM(United Nations High Level Meeting on TB )political declaration, every country must adopt and fully implement the following key policies: |

DIAGNOSING TB

RAPID MOLECULAR TB TESTS

  • This is the initial test for all people who need diagnosis, with specimen referral in place as needed.

Step Up for TB 2020 Report

  • 28/34 (82%) COUNTRIES’ policies indicate that a rapid molecular diagnostic is the initial test for all people with signs and symptoms of TB.
  • 17/34 (71%) COUNTRIES’ policies do not limit the use of rapid molecular diagnostics to certain facilities.

URINE-BASED TB LAM TESTS

  • All people living with HIV with signs and symptoms of TB, especially those with advanced HIV or who are critically ill should go with this test.
  • Policy adoption, implementation and scale-up of TB LAM has been entirely insufficient.

TB LAM Step Up Report

Reasons for non-adoption of TB LAM in diagnostic policies in 23 countries

COMPREHENSIVE UNIVERSAL DRUG SUSCEPTIBILITY TESTING

  •  It includes : rifampicin and isoniazid resistance for all people starting on treatment.

MEDICINES
Ifampicin, isoniazid, fluoroquinolones, bedaquiline, delamanid, linezolid and/or clofazimine are used for routine treatment.

TREATING TB

PEOPLE-CENTRED TB POLICIES

  • It including decentralised treatment initiation and follow-up at primary healthcare facilities and comprehensive treatment support and adherence counselling.

To improve treatment outcomes countries should explore systematic data collection on expanded use of bedaquiline and delamanid.

  • More than 77% of over 1,000 patients who received a longer treatment with bedaquiline and/ or delamanid experienced favourable treatment outcomes.

Step Up for TB Treatment

  • INJECTABLE-FREE : Injectable-free, all-oral regimens for all eligible people with drug-resistant TB.
  • PREVENTING TB : Shorter TB preventive treatment regimens prioritised for eligible people with latent TB infection, with adequate support to ensure treatment completion.

step up TB report UPSC

TB preventive treatment: 2018-2019 coverage versus UNHLM 2022 targets

  • SYSTEMATIC SCREENING : For active TB disease and testing for latent TB infection among household contacts and provision of TB preventive treatment to those without active TB disease, regardless of age.
  • ART INITIATION : Universal provision of TB preventive treatment for all people living with HIV. 

PROCURING MEDICINES FOR TB

  • STREAMLINED REGULATORY SYSTEMS : Approaches that encourage access to medicines, including mutual recognition between regulatory authorities, domestic registration etc.
  • FULL ALIGNMENT : Essential Medicines List inclusion is a prerequisite for medicines importation, with a plan for regular updates.
  • REQUIREMENT FOR WHO-PREQUALIFIED STATUS : Approval from an internationally recognised stringent regulatory authority for all TB medicines ; international or domestic manufacturers.
  • TRANSPARENT NATIONAL TENDERS : It including publication of selection criteria, winning bidder and final price information.

REASONS FOR NON PROCUREMENT

  • Not enough time to prepare for implementation
  • Lack of funding for procurement
  • Lack of funding for implementation
  • Medicines are too expensive

Not aware of WHO recommendation for shorter regimens 

  • National procurement and import regulations are prohibitive
  • Not aware of shorter regimens
  • Other reasons: no local evidence on the safety and cost effectiveness

      IASbhai WINDUP: 

Step Up for TB 2020 Report | UPSC

  • The report shows that many high-burden countries have yet to introduce much-needed policy reforms.
  • Countries only have two years left to deliver on the targets set at the UN.
  • To deliver change, countries must now step up and ensure full policy alignment with WHO guidelines by the next World TB Day.

Ultimately, countries’ successes will be measured in the pace of action and in lives saved; with two years to go, there is no time to waste.

SUGGESTED READING : DOWNLOAD REPORT 
     SOURCES:  THE IE   | Step Up for TB 2020 Report | UPSC

 

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