Higher targets set to eliminate TB

Rwanda has set new targets on prevention and treatment of TB (tuberculosis) as the World Health Organisation (WHO) raises a red flag on the disease that last year claimed 1.5 million lives globally.

Rwanda has set new targets on prevention and treatment of TB (tuberculosis) as the World Health Organisation (WHO) raises a red flag on the disease that last year claimed 1.5 million lives globally.

TB, WHO says in a new report, is only second to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.

The report says that last year, nine million people were diagnosed and 1.5 million died from the disease with most of the deaths occurring in low and middle-income countries.

In Rwanda, health officials say higher targets have been set to reduce infections and deaths in response to the WHO’s call to eliminate TB globally.

According to Dr Patrick Migambi, the Director of TB Infection Control and co-ordinator of TB prevalence survey, Rwanda has already hit the target of reducing 50 per cent of TB prevalence and death compared with 1990 baseline.

“We have a new target of 23 per cent reduction of TB incidence rate from 86.0 per 100,000 to 67.0 per 100,000 population and 37 per cent reduction of TB mortality rate from 10 per 100,000 to 6.3 per 100,000 population,” he said, adding that about 6,000 TB cases are diagnosed annually.

“Among 5,999 cases registered in 2012-2013, 85 per cent of them were successfully treated and 10 per cent of the patients died” he added.

Dr Michel Gasana, the head of TB Division at Rwanda Biomedical Centre, said many health facilities in the country still depend on old fashioned microscopes with low sensitivity to diagnose TB, making it difficult to effectively screen ailments like MDR-TB.

Globally, the WHO report indicates that about 550, 000 children became ill with TB and 80 000 HIV-negative children died of the infection last year.

TB is a leading killer of HIV-positive people, causing one fourth of all HIV-related deaths.

Globally in 2013, an estimated 480 000 people developed multidrug resistant TB even as the death rate dropped by 45% between 1990 and 2013.

An estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013.

There is currently ongoing research on a new tuberculosis vaccine for adults. The trial, scheduled to start early next year in South Africa, will be jointly conducted by the global non-profit biotech Aeras and drug manufacturer GlaxoSmithKline and aims to examine the prevention of Mycobacterium tuberculosis (Mtb), the bacterium that causes TB infection, through vaccination in adults for three years.

The trial will also evaluate the revaccination of the BCG vaccine. That is, evaluate the effectiveness of the vaccine when it is given for a second time.

In October this year, a new breath test for drug resistant tuberculosis that gives results within 10 minutes was developed by American scientists.

The researchers say the rapid test will lead to early diagnosis and treatment of multi-drug-resistance tuberculosis.

National efforts

Rwanda has few radiologists (about five or six), and most of them are in Kigali, which undermines diagnosis in rural areas.

But Gasana, however, said the government in recent years came up with various measures aimed at reducing TB mis-diagnosis. For instance, in the last two years, about 16 GeneXpert (highly sensitive TB detection) machines were procured and that plans are underway to get one for every district hospital in the next three years.

“The good news is that unlike before, the World Health Organisation has now approved the use of the GenXpert machine even on children, so cases of mis-detection will greatly reduce.”

He added that they are planning to use a digital network system that can, for instance, help a doctor and laboratory technician share an X-ray report of a particular patient quickly, helping with interpretation and advice where necessary, regardless of distance.

Gasana said the country had also acquired about 50 fluorescence microscopes, which have a 10 per cent higher sensitivity than ordinary ones, and that they are hoping to acquire 200 others over the next three years.

He also revealed that over $12 million is spent annually in the fight against TB by the Ministry of Health.