Juan Gonzalez, with his grandchild
When Juan González, a resident of Guadalajara, received a diagnosis of Tuberculosis (TB) in 2011, he did not know much about the disease. The only thing he was sure he knew was that ‘TB can be a death sentence’. He did not know that coughing was a sign of TB. He did not know he also had Diabetes and as such, his immune system was affected, making him more likely to develop active TB. He continued his work as a taxi driver until he had to be rushed to the hospital where he received a diagnosis of TB and then of Diabetes. Once diagnosed, Mr. González says he was lucky to have received the care and support from dedicated TB workers from the Ministry of Health. PCI had been working since 2006 with the national and state TB programs from 5 different states, to improve collaboration between TB-HIV/AIDS and TB-diabetes programs.
The story of Juan is not uncommon. Almost all of the persons affected by the TB that were diagnosed in the areas where PCI worked with the Ministry of Health from 2004-20012, when interviewed, said that they knew little about the disease at the time they were diagnosed. Mostly, they thought of TB as a ‘disease from the past’ or a ‘disease of the poor’, and none of them knew that TB was related to both Diabetes and HIV/AIDS.
According to the World Health Organization, one out of every three individuals in the world are infected with the TB bacteria. Only about 15% of those infected will develop the disease, but half of them will die if untreated. Globally, an estimated 8.7 million new cases of TB were reported in 2011, and in 2010, 1.4 million died from the disease. The growing problem of multi-drug resistant (MDR) strains of the disease which are much more difficult to treat and cost 100 times more (on average) to treat, is putting added pressure into public health systems that are already struggling to control the disease. In México, of the over 18,000 individuals diagnosed with TB in 2012, over 20% have diabetes and over 7% have HIV/AIDS. HIV/AIDS accounts for over 30% of the deaths in people with TB; and research conducted in México has shown that individuals with diabetes are 7 times more likely to develop tuberculosis than those without diabetes. Furthermore, half of the almost 500 cases of MDR TB registered in the country are individuals with diabetes.
TB is not a ‘glamorous’ disease, you will not find multiple funders seeking to support research or care, and even less pharmaceutical companies making significant investments in the development of new medications. The truth is, the treatment for primary TB has been the same for over 60 years, and the method of diagnosis most commonly used, sputum smear test, was invented in the 19th century. But TB is for the most part, a preventable and curable disease.
Over the past 8 years, PCI worked with the Ministry of Health in México to achieve important changes. In 35 priority municipalities from 13 different states throughout the country, the public health system integrated a person-centered approach into TB prevention and care. This allows people like Juan González to receive quality care from health workers who focus as much on his needs as on ensuring treatment completion. PCI worked with the National TB program to strengthen their collaboration with the Diabetes and HIV/AIDS departments to successfully integrate screening and referrals for HIV/AIDS and Diabetes for those with TB, resulting in over a 70% increase in screening for both diseases. At a macro level, the testing of HIV for people affected by TB was incorporated as part of a set of ‘indicators of excellence’ that the Ministry of Health uses to assess the annual performance of the 32 state health deapartments in the country; by the end of the 2012, PCI and the National TB Program convened clinical and basic-science experts to discuss the state of TB-HIV/AIDS and TB-diabetes comorbidities care and prevention in the country and identify key recommendations to improve screening and referrals. México is recognized as a pioneer in TB-diabetes collaboration in the Americas.
These and other transformational events are in place now in México to support health workers’ fight against Tuberculosis, but the fight is not over. TB should be positioned higher in the public health agendas.
All over the world, we publich health workers call for:
• Zero deaths from TB
• Universal access to TB care
• Faster treatment
• Quicker and low-tech testing methods
• An effective vaccine
As the theme of World TB Day indicates, we can put an end to TB during our lifetime.
For more information on PCI’s TB programming in México, visit PCIGlobal.org; for more information on the STOP TB partnership’s World TB Day resources visit: http://stoptb.org/events/world_tb_day/2013/