New survey finds millions of people affected by tuberculosis still diagnosed and treated with outdated tools

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The Stop TB Partnership (STBP) has released Step Up for TB 2020, a new report prepared with Médecins Sans Frontières (MSF), which 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, one of the world’s leading infectious killers, a situation that is further exacerbated by the negative impact of the COVID-19 pandemic on people affected by TB.
Global efforts to end TB received a boost in 2018 during the United Nations High-Level Meeting on TB, when world leaders agreed on a set of ambitious targets to be reached by 2022. However, progress on implementation of the 2018 UN Political Declaration on TB has stalled and even rolled backwards in the context of COVID-19. The new report calls on countries to urgently update their TB policies and recommendations as a crucial first step towards ensuring the funding, scale-up and implementation of comprehensive TB responses.
Step Up for TB 2020 examines the national policies of 37 countries with a high burden of TB, assessing the extent to which they align with World Health Organization (WHO) guidelines and international recommendations. With an estimated 7.7 million people developing TB each year, these 37 surveyed countries represent 77% of the global TB burden and 74% of the estimated burden of drug-resistant TB.
“Earlier this year, the COVID-19 pandemic hit the world with devastating impact, and governments around the world quickly adopted new policies and laws in response,” said Dr. Lucica Ditiu, STBP Executive Director. “Meanwhile, TB remains the top infectious disease killer, even though it is preventable and curable. To make matters worse, most countries still use outdated policies, practices, tools and treatment regimens. Our survey, which is conducted regularly, shows improvements every year, but we have a long way to go. We all must ensure that every single person affected by TB is diagnosed and treated using the latest available international guidelines and tools.”
Previously known as Out of Step, this fourth edition in the series covers a larger set of countries and additional policies and practices related to four key areas: diagnosis, treatment, prevention and medicines procurement.
On diagnosis, 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 the disease that is resistant to existing treatments. Of them, only 1% can hope to access comprehensive universal drug sensitivity tests, as 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. But a mere 14% of those countries have put policies in place that allow for the use of lateral flow urine lipoarabinomannan assay (LAM) testing for TB, which has been internationally recommended since 2015. This leaves more than 17 million people living with HIV without access to a rapid, affordable and life-saving TB diagnostic tool.
There is, however, some positive news on diagnostics policies. Countries made progress on certain key indicators since 2017 when the last report in this series was published. For example, 80% of surveyed countries—with more than 1.5 billion inhabitants—indicate that they are now able to use rapid molecular TB tests as the initial test for people with symptoms of TB, finally moving away microscopy. However, most countries do not seem to have implemented this policy at scale; this should be a priority.
Alarmingly, when it comes to treatment, nearly 39% of countries are likely to still use injectable medicines to treat drug-resistant TB (DR-TB) among adults, having failed to update the relevant policies in line with the latest international guidance. STBP calls for an immediate halt to the use of TB treatment involving injectables; oral medicines should be used instead, as recommended by WHO since 2018.