TUBERCULOSIS

:: Box 6.3
After Ebola: enhancing the capacity
for TB and MDR-TB diagnosis
In 2015, some 29 809 TB cases were reported in the
three post-Ebola West African countries: Guinea, Liberia
and Sierra Leone. WHO estimates that Liberia and Sierra
Leone are among the 10 countries with the highest TB
rates per capita worldwide. Reported cases for the three
countries represent only 42–60% of the estimated
incident TB cases, a and population-based surveys are
needed to improve estimates. With financing from the
United States Agency for International Development
(USAID) and from the Global Fund, WHO is supporting
the strengthening of TB capacity accompanying other
efforts to strengthen health systems.
During the Ebola outbreak, Guinea, Liberia and Sierra
Leone all received support from partner agencies to
introduce GeneXpert instruments for Ebola screening.
As these countries transition from the outbreak response
to routine disease surveillance, an opportunity has
arisen for the integration of these instruments into
the general laboratory network, including for testing
for TB, rifampicin-resistant TB and HIV viral load. A
review of the current placement of the machines will
inform the best deployment to serve the multiple needs
of the populations covered. The assessment is taking
into consideration epidemiology, availability of other
companion diagnostic tools, laboratory personnel and
power supply. In all three countries, WHO is supporting
the data managers of the TB programmes to map TB
cases notified by prefecture or district, and to calculate
needs for the rapid molecular diagnostic tool based on
recommended diagnostic algorithms. The Foundation
for Innovative New Diagnostics (FIND), a non-profit
public–private partnership that helps to enable evidence
generation and roll-out of new diagnostic tools, is
providing training using the Global Laboratory Initiativeendorsed
Xpert MTB/RIF training package.
Other health systems platforms that emerged in
response to the Ebola outbreak can also improve timely
TB diagnosis. For example, in 2015, the Ministry of
Health and Social Welfare of Liberia invited Riders for
Health (RfH), an NGO, to manage their fleet of 250 new
vehicles and 200 new motorcycles donated during the
Ebola outbreak. RfH offers transportation of medical
samples to the nearest laboratory for testing. Planning
is underway, with NTP and Global Fund financing, to
enable transfer of sputum samples from anywhere in
the country to Xpert MTB/RIF sites and the central TB
laboratory.
a
42% estimated case detection coverage in Liberia, 55% in Guinea
and 60% in Sierra Leone.
economic growth. Social protection can build resilience to
risks and shocks, advance equity in assets and access to
services, and improve economic and social opportunities. 1
The International Labour Organization coordinates efforts
to promote social protection “floors”; that is, “nationally defined
sets of basic social security guarantees that should
ensure, at a minimum that, over the life cycle, all in need
have access to essential health care and to basic income
security which together secure effective access to goods
and services defined as necessary at the national level”. 2
The SDGs include a social protection target (Target 1.3),
which is to “implement nationally appropriate social protection
systems and measures for all, including floors, and
by 2030 achieve substantial coverage of the poor and the
vulnerable”. 3
In TB care, patient economic support today may include
(for at least some patients) cash transfers, food packages
or nutritional support, toiletries or transport vouchers.
Also, in fewer cases, it may include access to social benefits,
sickness insurance or disability grants, and explicit
protections of rights to work, housing and health-care access.
Both economic and nutritional support can be important
for TB patients. Economic support is often critical as TB disease
is strongly related to poverty, and seeking and staying
in TB care can be impoverishing. Nutritional care is needed
to improve nutritional recovery for those TB patients who
are undernourished before and/or during TB treatment. 4
Few TB patient support packages are well documented
and evaluated. Improved design, management and evaluation
may help, but stand-alone TB-specific approaches
may be hard to sustain. For greater coverage and impact,
making more use of developed or nascent national social
protection platforms is a priority. 5 Review of documentation
on cash transfer programmes by the WHO Global TB Programme
suggests that at least 13 of the highest TB burden
countries have experience with large-scale cash transfer
schemes beyond TB, 6 although many such schemes still
have financial and administrative constraints. Table 6.1 illustrates
the TB-specific and broader approaches available
in some high TB burden countries.
With documentation from partners, WHO included
pointers on effective social protection in Implementing the
1
World Bank. Managing risk, promoting growth: Developing systems
for social protection in Africa. The World Bank’s Africa Social
Protection Strategy, 2012-2012. Washington: World Bank, June 2012.
2
International Labour Organization. World social protection report
2014/15: building economic recovery, inclusive development and
social justice. Geneva: ILO; 2014 (http://www.ilo.org/global/
research/global-reports/world-social-security-report/2014/
WCMS_245201/lang--en/index.htm, accessed 6 September 2016).
3
United Nations. Transforming our world: The 2030 Agenda for
Sustainable Development. New York: UN; 2015. (https://
sustainabledevelopment.un.org/post2015/transformingourworld/
publication, accessed 5 September 2016).
4
World Health Organization. Nutritional care and support for people
with tuberculosis. Geneva: WHO, 2013.
5
World Health Organization. Implementing the end TB strategy: the
essentials. Geneva: WHO, 2015.
6
Brazil, China, Ethiopia, India, Indonesia, Kenya, Mozambique, Namibia,
Nigeria, Pakistan, South Africa, Tanzania and Thailand.
98 :: GLOBAL TUBERCULOSIS REPORT 2016