Targeted interventions – Ending TB epidemic

What is the issue?

There is a need to provide rights-based interventions for TB patients instead of mere surveillance technologies.

What are the concerns with technological interventions?

• Tuberculosis (TB), being a curable and preventable disease, is becoming the leading cause of adult deaths in most of the global south, which kills nearly two million people a year.
• The United Nations recently made a declaration, through which heads of state and government have reaffirmed their commitment to end the global TB epidemic by 2030.
• However, emergence of surveillance technologies has threatened to detract from an effective response to TB that is anchored in human rights and has a human touch. 
• For example, Directly Observed Treatment, short course (DOTS) strategy requires patients to report every day to a health authority, who watches them swallow their tablets.
• However, in recent times, governments use a strategy of video, tablets, phones and drones to carry the old DOTS strategy into the technology era.
• India also planned recently to implant microchips in people in order to track them and ensure they complete TB treatment.
• The response through these interventions seems to be not with and for people who have TB but rather against them.

What should be the targeted areas?

• Providing new treatment - New guidelines by the WHO recommend the use of bedaquiline and delamanid against drug-resistant TB, which are proved to be effective.   
• However, only about 30,000 people have received these new drugs, though over 500,000 people get sick with drug-resistant TB every year.  
• Exorbitant prices for these drugs is one of the reasons for the exclusion of vast majority of people from accessing it.
• Thus, International institutions, donors and countries need to focus and collaborate on the urgent production and distribution of affordable generics of bedaquiline and delamanid.
• Engaging community health-care workers – They can lead the response by bringing responsive care to those regions, where the reach of traditional health-care systems is very low.
• For that, they should be equipped with proper training and dignified conditions of employment.
• WHO should focus on recommendations around this cadre of workers and donors should focus funding to programmes that make the most of them.
• Ensuring accountability - Community-based structures such as “clinic committees” ensure accountability while also fostering partnership and trust between communities and their health-care systems.
• Grassroots civil society and community-based organisations also ensure accountability.
• Such organisations are indispensable and would thrive on comparatively small amounts of funding.

What needs to be done?

• The Indian government has made an aggressive resolve to end tuberculosis (TB) by 2025, 10 years ahead of the WHO’s goal.
• Eliminating TB needs an approach focusing on creating health systems that foster trust, partnership and dignity. 
• Thus, instead of mere surveillance technology, any strategy to eliminate TB should regard people with TB not as subjects to be controlled but as people to be partnered with.

Source: The Hindu