Tuberculosis (TB) is a contagious but curable and preventable disease caused by Mycobacterium tuberculosis and attacks the lungs (pulmonary TB). It also affects other organs in the body (extrapulmonary TB).

Pulmonary TB is passed from one sick TB patient to another as a droplet infection through coughing, singing and sneezing. All age groups and all societies are susceptible to tuberculosis.

Ghana’s national tuberculosis incidence rate is approximately 144 per 100,000 population at the end of 2019. In 2003 (57 years after its first survey), Ghana conducted a second TB prevalence survey nationally and found a national prevalence of tuberculosis estimated at 290. per 100,000 population.

Suffice it to say that the disease burden of tuberculosis was about four times higher in 2003 than World Health Organization (WHO) estimates for the same year (71 per 100,000 population).

Petrified Global Killer

Alarmingly, tuberculosis is one of the top 10 causes of death in the world and according to the WHO, around 1.4 million people die from tuberculosis each year worldwide.

Inferentially, tuberculosis is one of the leading causes of death in the world, ranking alongside HIV / AIDS. Sadly, tuberculosis places its greatest burden on the world’s poorest and most vulnerable, exacerbating existing inequalities. The fight against tuberculosis must be stepped up through universal health coverage (UHC) especially during the COVID-19 pandemic.

TB and CSU

The United Nations Tokyo Declaration in 2017 adopted UHC in 2017 to reduce barriers to accessing quality health services around the world.

Accordingly, the concept of UHC requires that all people can have equitable access to quality health services without financial, geographic, social and other barriers.

The 3rd and 8th targets of the third Sustainable Development Goal (SDG3) refer respectively to the eradication of tuberculosis and the achievement of UHC by 2030.

Tackling TB through UHC in the COVID-19 era means that the health sector must provide UHC-focused services that are affordable, appropriate, accessible and responsive to TB eradication.

Thus, SDG3.3 revolves around the strategic fight against tuberculosis on three pillars, namely:

1. Integrated, person-centered care and prevention of tuberculosis.

2. Bold policies and support systems that ensure UHC, social protection, poverty reduction and action on the social determinants of TB.

3. Intensification of research and innovation in tuberculosis and HIV.

TB and COVID-19

My hunch is that if not careful, the current global attention to COVID-19 will distract most countries, including Ghana, from the fight against TB. This will happen if the TB cases are symptomatic and treated as COVID-19 cases.

Indeed, even though tuberculosis and COVID-19 are two different infectious respiratory diseases, the two diseases share certain constitutional symptoms such as cough, fever, shortness of breath, fatigue and loss of appetite.

Therefore, patients who present with the common symptoms of tuberculosis and COVID-19 are advised to be tested for both conditions in order to facilitate the most appropriate and targeted treatment regimen. In my opinion, this is the only way that Ghana, and for that matter, the world will not be misled to diagnose TB cases as COVID-19.

Apart from COVID-19, tuberculosis is also linked to HIV / AIDS. Globally and in Ghana, tuberculosis is the most common opportunistic infection with a high death rate in people infected with HIV. In fact, out of about 1.5 million people who died from TB in 2020, about 214,000 were people with HIV / AIDS.

Funding

The Global Fund provides free TB diagnosis and treatment in Ghana through the National Tuberculosis Control Program (NTCP).

As a result, the NTCP is providing tuberculosis diagnostic equipment and drugs to various public health facilities across the country.

Despite this gradual TB control effort in Ghana, the harsh reality is that some TB patients are unable to easily access sustained treatment, resulting in high dropout rates.

This is because some of these patients do not have reliable sources of income and are therefore unable to pay regular transport costs to and from health facilities providing TB treatment.

In some cases, TB treatment centers are geographically inaccessible to other significant people living with the disease.

Some of these barriers to early detection and sustainable treatment of tuberculosis lead to multidrug-resistant tuberculosis (MDR-TB).

Multidrug-resistant tuberculosis occurs when the tuberculosis bacteria do not respond to treatment due to incorrect prescriptions by health care providers, poor quality medicines and patients who stop treatment prematurely.

In the past, the Global Fund provided financial support that covered the transportation needs of patients with TB, but in recent times this support is only intended for patients with MDR-TB.

Recommendations

Achieving the SDG targets on TB and UHC requires multi-pronged approaches to defeat the disease in the COVID-19 era, as this will help achieve greater treatment success for all forms of TB.

The COVID-19 pandemic must not distract us from our sustained fight against tuberculosis. As a result, patients who have common symptoms of COVID-19 and tuberculosis should be tested for both diseases before a treatment regimen is prescribed.

Making TB treatment accessible to everyone, even hard-to-reach people in the country, through the implementation of UHC, requires the government to make TB diagnostic and treatment services accessible in all regions. from the country.

In this regard, special purpose vehicles can be purchased to serve as mobile TB clinics that step up early detection of TB cases and bring TB to the doorstep of people, especially the most vulnerable in society.