September 5, 2024
Leveraging Tuberculosis Programs for Future Pandemic Preparedness: A Retrospective Look on COVID-19
A new report in PLOS, “Leveraging Tuberculosis Programs for Future Pandemic Preparedness: A Retrospective Look on COVID-19,”shows that countries with stronger tuberculosis (TB) programs and investments better responded to COVID-19 and their TB programs experienced fewer disruptions.
The report was co-authored by Friends President and CEO Chris Collins as well as Whitney Bowen, Tri Ho, Sebastian Romero, Roaa Shaheen, Victoria Kipngetich, Nick McGowan, Sungho Moon, Esha Bhattacharya, Robert Hecht and Shan Soe-Lin with Yale University.
According to the report:
- Countries that were able to maintain high rates of TB financing were associated with fewer COVID-19 deaths.
- Countries with more efficient TB programs were able to better control COVID-19.
- Higher proportions of Global Fund financing led to better TB and COVID-19 outcomes. For high-burden TB countries, a positive association existed between a higher proportion of Global Fund funding and TB program recovery during the COVID-19 pandemic.
- Countries that had better COVID-19 recovery rates prioritized using trusted local community groups to ensure continuity of care for existing TB patients and navigate around disruptions caused by lockdowns.
- The TB platform can be quickly used to detect and respond to new respiratory pandemics. Any broader pandemic preparedness plan must leverage TB programs.
Excerpts from the report:
In Sierra Leone, public health authorities and international agencies, such as Medecins Sans Frontieres (MSF), piloted programs to train locally trusted traditional healers and workers in detecting potential TB symptoms in patients and referring them to local clinics. Beyond increasing the TB detection rate, this built locals’ trust in public health efforts due to the involvement of authority figures already trusted by the community.
In Pakistan, understanding that private health clinics were generally more trusted by the populace due to their embedded nature in local communities, international NGOs created and funded local initiatives to ensure continuity of care for their TB patients even during nationwide private health care facility shutdowns.
During the acute phase of the COVID crisis, many countries diverted funding and staff away from TB and other basic health programs towards COVID-19 management. Resilient countries, however, took the approach of treating both TB and COVID-19 as co-epidemics and continued to support and resource TB and COVID-19 programs together, avoiding a disease-siloed response.
As an example, bidirectional screening played a large part in the maintenance of Nigeria’s TB response during COVID-19. Wellness on Wheels Mobile Units were equipped with GeneXpert instruments and digital X-ray machines that allowed for mobile case finding, referring TB-positive individuals to treatment health facilities while dually screening for COVID-19. They played a key role in increasing TB case notification rates in Nigeria throughout the pandemic, optimizing patients’ time and healthcare resource utilization while expanding patients being tested for TB during the acute pandemic period.
Most countries took an all-of-society approach to COVID-19, incorporating various levels of government and private partners into the strategy and management of the pandemic response; the success of these strategies suggests this approach should be replicated against other diseases. As observed in Nigeria, increased public-private coordination resulted in the alignment of COVID-19-era TB patient care procedures, ensuring continuity of care for all patients despite pandemic restrictions.
In the Central African Republic (CAR), the WHO coordinated the development of local micro-plans to effectively combat TB. These included targets and reporting gaps; mapping and inventory exercises; and specimen transport strategies. Additionally, twenty-three GeneXpert machines were purchased and distributed amongst regional facilities in the CAR to facilitate increased access to high-quality laboratory COVID-19, TB and HIV testing. This decentralizing pandemic response strategy led to a four-fold increase in laboratory TB tests conducted, with an increase anticipated as COVID-19 testing capacity requirements decrease.
The case of Pakistan is notable due to the engagement of the traditional TB response with delivery and courier systems already in place. The National TB Control Programme meticulously located all registered patients and utilized courier services like the Pakistan Postal Service, and private delivery services such as Uber, Bykia, or other local arrangements to ensure uninterrupted drug supply. The program also revolutionized sputum transport protocols through digitized transportation systems that operated at the district level and included an online tracking dashboard.
Nigeria also exemplified rapid adaptation throughout the pandemic with its robust eHealth technologies. The mobile app TB Screening and Tracking for Accelerated Referral and Reporting enabled providers to report TB service delivery data and monitor performance in real time. Additionally, it fast-tracked the distribution of additional anti-TB drug stocks to private facilities.
Fundamental to the achievements of the aforementioned case studies are the sustained funding sources supplied by international financing and partnership organizations, specifically the Global Fund. Nations that have received investments from the Global Fund have historically demonstrated success in improving TB-related statistics.
In India, an investment of approximately $1.1 billion yielded a 22% decrease in TB incidence rate per 100,000, an 8% decrease in TB deaths, and a 38% increase in HIV and TB patients on antiretroviral treatment. In Nigeria, an investment of approximately $450 million yielded a 17% increase in MDR-TB treatment success rate, while also increasing HIV and TB patients on antiretroviral treatment by 58%. Following COVID-19, supplemental investments by the Global Fund from 2021-2023 through the form of grants, totaling approximately $154 million, have further contributed to Nigerian access to comprehensive, high-quality, patient-centered, community-owned TB services.
To date, the Global Fund has invested nearly $10 billion in addressing TB since 2002. Considering that the Global Fund provides as much as 76% of all international funding towards TB treatment, the tremendous significance of ensuring sustainable funding sources for the Global Fund cannot be understated.