3 Strategies for TB Prevention, Treatment and Elimination

How to turn the UN Political Declaration on TB into practice

United Nations building
The United Nations issued a political declaration to end TB. Three strategies should be leveraged to achieve those goals.

Recently, the United Nations issued a political declaration at the High-Level Meeting on Tuberculosis (TB) to rally an urgent global response to a global epidemic. This meeting and several of the related events, including a TB Innovation Summit hosted by Johnson & Johnson and Accelerating the Global TB Response through Technical Innovation hosted by Nikkei, signal that we are truly at a tipping point for TB care. Globally, we have come to the realization that the status quo is insufficient. It is up to all of us to change the way care is delivered because complacency kills.

A political declaration is only useful if accountability, metric tracking, and consistent funds to support new initiatives are maintained. It is the responsibility of the TB community as a whole to contribute to progress in TB elimination in accordance with the objectives of the declaration.

Here are three ways to make the political declaration a reality:

Make economic arguments to expand TB treatment with new partners

TB programs go above and beyond for their patients and deliver a value not only to the patients they cure, but to health systems as a whole. Community health workers, nurses, and providers regularly engage with patients to provide assistance to their overall health -- often times at their own expense, such as providing heaters or coats during winter months. Often, this value does not get the recognition it deserves. Part of this is because value to many stakeholders is quantified in dollars and cents. However, programs consider going the extra mile a norm to cure patients and prevent the spread of disease.

To truly expand TB treatment options, particularly latent TB treatment options like 3HP that can be most efficiently scaled within the private sector, sustainable collaborations with strong economic arguments need to be made. To advocate for necessary funding, programs must first establish baseline program costs and prove that improvements, such as implementing video DOT, are working. The recent CDC Program Evaluation Network conference hosted an interactive workshop on the “Economic Costing of Video DOT Programs: DIY for Local Health Departments” that helped quantify cost savings of implementing video DOT, which included examining factors like staff time, average duration of treating a patient, mixed models of DOT delivery, vendor costs, vehicle maintenance and gas costs, and hardware.

TB programs save money, deliver critical services, and help to prevent costly consequences of the spread of disease. It is time to leverage that expertise to foster engaging, effective partnerships that align financial incentives.

Adopt new evidence-based interventions to accelerate case decline

In the United States, the TB case rate is 28 times higher than the elimination target. We have hovered below 10,000 cases over the last 5 years without much of a steep decline. Achieving this goal is nearly impossible if we do not prioritize implementing and scaling new, effective interventions to accelerate the case decline from 2-3 percent per year to 10-15 percent per year. Several examples of promising interventions include adopting digital technologies to support medication adherence and offering shorter regimens to encourage higher treatment completion rates.

Staying up-to-date with promising interventions abroad can also encourage innovation domestically. For example, Fujifilm and the Foundation for Innovative New Diagnostics have developed a urine-based point-of-care test for diagnosing TB among people living with HIV. Additionally, significant progress has been made on TB vaccines with one showing 54 percent protection.

Combat the TB invisibility crisis through advocacy & communication

TB is often categorized as an ancient disease. As a result, it is not top of mind and many find it surprising that TB is still the world’s deadliest infectious disease. A lack of awareness of the scope of TB burden, particularly in low-incidence countries like the United States, perpetuates stigma for people with TB and presents constant funding challenges for programs combating the disease.

The only way to change the narrative is through advocacy and education. Here are two examples of that:

  1. We are TB works with public health leaders to educate the Americans on TB prevention and control. As TB survivors, they believe that the real-life experience and emotional depth that their organization adds to conversations about TB can increase awareness about the realities of the disease.

  2. Diary of a Modern Consumptive is a newly released book that details the first-hand account of multi-drug resistant TB survivor, Paul Thorn, who acquired the disease due to poor hospital infection control policies. It sheds a light onto the feelings, barriers, and considerations people living with TB and people who have survived it go through during and after treatment.

Learn more about the UN High Level Meeting on TB and important aspects of the political declaration.