Caribbean countries in the forefront to eliminate TB

Dr. Carissa Etienne, PAHO Director 2018-2023

Caribbean countries have the lowest incidence of tuberculosis (TB) and are on the road to elimination, the Pan American Health Organisation/World Health Organisation (PAHO/WHO) said Tuesday.

They said the region of the Americas is the area with the lowest percentage of new TB cases in the world, estimated at three per cent, and is the first region with a real opportunity to eliminate the disease as a public health problem.

According to the “Tuberculosis in the Americas 2018 “report, 15 countries,12 of them from the Caribbean, have low TB incidence, with less than 10 cases per 100,000 people and are on the road to elimination.

“Countries are adopting measures to tackle TB, but they cannot lower their guard and must redouble efforts, along with the collaboration of society at large, including the affected communities” said Marcos Espinal, Director of PAHO’s Department of Communicable Diseases and Environmental Determinants of Health.

The report’s other recommendations for accelerating progress toward eliminating TB, especially in the countries with the greatest disease burden, include: promoting the study of contacts with people who have TB, especially children under 15; stepping up implementation of simpler treatment regimens and introducing drugs for children.

Other recommendations include reaching the most vulnerable populations and addressing social determinants as well as ensuring that plans are financed with a country’s own resources rather than depending on external funds.

According to the new report, issued on the eve of the first United Nations High-level Meeting on Ending TB, between 2000 and 2015, deaths from tuberculosis fell by 37.5 per cent in the Americas and new cases dropped by 24 per cent.

However, the report, which provides a complete and updated assessment of the TB epidemic and progress made in treating and preventing the disease in the region, noted that the rate of decline must be accelerated for the region to be able to end the disease.

In 2017, the WHO estimated 282,000 new cases of TB in the Americas, 11 per cent of which were in people living with HIV.  An estimated 24,000 people died last year from tuberculosis in the region, and 6,000 of them were co-infected with HIV.

“Ending TB will only be possible if we step up the reduction in new cases and deaths,” said PAHO Director, Dr. Carissa F. Etienne.

“We need to expand access to diagnosis and quality treatment for everyone who needs it and to address social determinants that affect health and favour transmission of the disease,” she noted.

The report notes that although preventable and curable, tuberculosis is currently the region’s most lethal infectious disease and its persistence is largely due to the serious social and economic inequities in the Americas.

Since 2015, deaths fell on average by 2.5 per cent per year and new cases dropped by 1.6 per cent, but they need to fall at a rate of 12 per cent and eight per cent per year, respectively, to achieve the intermediate targets for 2020 and continue to decline until 2030.

Ending the worldwide tuberculosis epidemic is one of the targets of the Sustainable Development Goals (SDGs).

WHO’s End TB Strategy, adopted by the World Health Assembly in 2014, aims to reduce deaths from TB by 90 per cent and the incidence of the disease by 80 per cent by 2030, compared to 2015 levels.

The report notes that more than 50,000 people in the region, almost half of them under 15 years of age, o not know they have the disease and have not been treated.

“This diagnostic gap increased by 3,000 people, compared to 2016. Rapid diagnostic testing, a new tool that could help to close the gap, was used in just 13 per cent of diagnosed cases, up slightly from nine per cent in 2016.

The two United Nations health organisations said that treatment for TB has saved thousands of lives. However, in the last five years 75 per cent of patients were cured, which is below the target set for 2030.

To step up progress, the report recommends that countries improve patient monitoring to ensure follow-through on treatment and address access barriers to health care, among other issues.

It said that multidrug-resistant tuberculosis is also a serious threat, with an estimated 11,000 people in the region currently infected by this form of the disease. Among those who develop it, the cure rate is just 56 per cent.

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