Goa to Paris: Growing call to find all TB to stop TB

Shobha Shukla / Bobby Ramakant *

Not just a Portuguese connect, Goa also has a Paris link now. The “Global Call to find all TB to stop TB” which was launched earlier this month in Goa, India was in prime spotlight at the World Conference on Lung Health 2023 in Paris.

The Paris conference reverberated with the loud and clear call: “We must find all TB to end TB”, given by Dr Guy Marks, President of the International Union Against Tuberculosis and Lung Disease - The Union. This was followed by the unambiguous statement: “The best treatments in the world will not be useful if we cannot find the people who need them,” of Dr Nina Russell, Bill and Melina Gates Foundation.

Find all TB to stop TB

Earlier this month in Goa, a multistakeholder conference on the theme “Find All TB to Stop TB” opened with recommendations from a consultative conference held right after the United Nations High Level Meeting on TB in Virudhunagar, Tamil Nadu, India, and hosted by Rainbow TB Forum and Blossom Trust.

One of the recommendations was: “India has efficient TB testing methods (such as, WHO recommended laboratory-independent, point-of-care and de-centralised molecular test), but we need to make sure that everyone has access to them as per the World Health Organization (WHO) guidelines.” First action point that emerged from this conference was: “We need to ensure that TB tests that underperform- like smear microscopy- are replaced 100% by laboratory-independent, point-of-care and decentralised molecular testing at the earliest, and communities are made aware about their existence and demand for them.”

The science- and evidence-backed call to governments globally, to replace microscopy with upfront rapid molecular test for TB (because microscopy underperforms in diagnosing TB and thereby misses TB cases) has been there since several years – but shockingly, action has been sketchy. This call to replace microscopy with upfront molecular tests is also among the key actions enshrined in the WHO Director General’s flagship initiative to Find.Treat.All (first launched in 2018). One of the promises that was made by world leaders at the recently concluded UN High Level Meeting on TB in September 2023 also re-echoed this call for 100% upfront molecular testing for TB.

But action is dismal. The latest WHO Global TB Report 2023 released earlier this month shows that more than half of notified cases of active TB disease did not receive a molecular test but got a microscopy test which misses TB (globally only 47% of notified people with TB received a molecular test diagnosis in 2022).

Early and accurate diagnosis breaks the chain of TB transmission

Presenting the Global Call to “Find All TB to Stop TB” in an official press meet of the World Conference on Lung Health in Paris (www.bit.ly/findalltb), Dr Tara Singh Bam (The Union’s Asia Pacific Regional Director) shared that this call has received over 250 endorsements from over 30 countries worldwide in less than two weeks since its launch in Goa, India.

“Early and accurate TB diagnosis is not only a critical gateway to TB care pathway, but also a public health and human rights imperative. It helps stop the spread of TB infection as well as reduces unnecessary human suffering and risk of untimely deaths due to TB,” added Dr Tara Singh Bam, who is also the Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT). APCAT had co-hosted the ‘Find All TB to Stop TB’ meet in Goa, India, along with TB People (India), Asia Pacific Media Alliance for Health and Development, Global AMR Media Alliance (GAMA), Molbio Diagnostics, Journalists Against TB, and other partners.

Bring lab to the people

Bringing “lab to the people” (and not people to the lab) is the first vital step towards finding TB. If we fail to do this, we will keep missing TB cases despite having the best of tools in the labs. Additionally, we must ensure that the full cascade of TB care services is people centred.

"We have to rethink what are the missing services that are failing us on #EndTB. One of the urgent priorities is to bring WHO recommended TB diagnostics closer to the point-of-need," rightly said Tariro Kutadza, a force for change for people-centred TB and HIV responses in Zimbabwe and Southern Africa. She is also represented on the Union Community Advisory Panel.

The global call to find all TB to stop TB has 1 key ask: stop missing TB cases. We can stop missing TB cases with at least two actions: firstly, we need to ensure that 100% replacement of smear microscopy with WHO recommended molecular tests becomes a reality as soon as possible, along with a paradigm shift from a lab-centric to a fundamentally people-centric model to diagnose TB, leaving no one behind. Secondly, we have to find the people which the TB programme is currently missing. We have to screen all people with TB in high burden settings and offer them best of molecular testing and linkage to TB care continuum.

End the deadly divide between Global Goals and Local Realities

“We must translate the Global Goals and Agenda 2030 at local level. We have global goals but why are there no local goals and targets?” rightly asks Dr Tara Singh Bam. We have to end the deadly divide between global goals and local realities first if we are to progress towards sustainable development.

Dr Bam stressed upon pivotal leadership of sub-national governments in translating global promises into ground realities. Failing to engage local leaders for a well-coordinated integrated health response will also wreak havoc on sustainable development.

“End TB agenda warrants action from not just the health sector but all other sectors. Whole of society and whole of government approach is critical especially at the sub-national level to advance progress on Find All TB, Treat All TB, and Prevent All TB,” said Dr Bam. We must protect not only the rights and responsibilities of people with TB but also those without TB as they may be at risk of TB.

Agrees Dr Guy Marks, President of The Union. “We have focussed almost entirely on people who have TB and their immediate contacts but in fact we have not focussed enough on the rest of the community who do not have TB, and who do not want to get TB. We need to focus on the rights of people to protect themselves from getting TB in high burden settings.”

In a high TB burden setting, everyone is exposed to the TB bacteria. “That is why we have to screen everyone for TB, find all TB, treat all TB,” said Dr Marks.

Over 70 years ago when there was no TB treatment, people with TB were housed in sanitoria to prevent further infection transmission. But now with effective TB treatments, people with TB disease become non-infectious soon after being put on treatment.

“In high TB burden settings, many people with TB may not have symptoms. It is important to screen everyone with WHO recommended tools and offer them WHO recommended molecular test upfront and get them onto treatment quickly.

What is the right TB target?

“The right TB target should not be the number of people we find with TB, but those we do not find,” said Dr Guy Marks. We have to stop missing all TB cases if we are to end TB.

Endorse the global call to find all TB to stop TB: www.bit.ly/findalltb