Pakistan fifth highest TB burden country in world

A week before World TB Day will be observed globally, including Pakistan on 24th March for the second time with the slogan “Stop TB in my lifetime”, the World Health Organisation (WHO) is focusing on bridging the funding gaps for TB prevention and control efforts.
The overall stress would be on increasing funding for TB prevention, care and control efforts, while enhancing awareness of key progress in TB interventions and actions required for further progress. It was against this backdrop that today in Geneva the WHO and the Global Fund to Fight AIDS, TB and Malaria (GFATM) said that strains of tuberculosis with resistance to multiple drugs could spread widely and highlighted an annual need of at least US$ 1.6 billion in international funding for treatment and prevention of the disease.
WHO Director General Dr Margaret Chan and GFATM Executive Director Dr Mark Dybul said that the only way to carry out the urgent work of identifying all new cases of tuberculosis, while simultaneously making progress against the most serious existing cases, would be to mobilise significant funding from international donors. With the overwhelming majority of international funding for tuberculosis coming through the Global Fund, they said, it was imperative that efforts to raise money would be effective this year. Growing alarm about the threat of multi-drug resistant TB, also known as MDR-TB, was making that even more pressing.
“We are treading water at a time when we desperately need to scale up our response to MDR-TB,” said Dr Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”
The WHO and the GFATM have identified an anticipated gap of US$1.6 billion in annual international support for the fight against tuberculosis in 118 low and middle income countries on top of an estimated US$3.2 billion that could be provided by the countries themselves. Filling this gap could enable full treatment for 17 million TB and multidrug-resistant TB patients and saved six million lives between 2014 and 2016.
While the Millennium Development Goal of turning around the TB epidemic had already been met globally, the two percent decline in the number of people falling ill with TB each year remained slow. WHO worked with the Global Fund and the Stop TB Partnership to support selected high TB burden countries in reviewing their priorities for the next three years and estimating available funding and gaps. In addition to the US$1.6 billion annual gap in international financing for the critical implementation interventions above, WHO and partners estimated that there was a US$ 1.3 billion annual gap for TB research and development during the period 2014-2016, including clinical trials for new TB drugs, diagnostics and vaccines.
Pakistan which had the fifth highest burden of tuberculosis in the world and the fourth highest in terms of multi-drug resistant (MDR) tuberculosis was working on many fronts to address the problem with the technical support of WHO, and financial support of GFATM, USAID, KNCV, JICA, DFID and a number of other development partners. A tripartite agreement between the National TB Control Programme, WHO Pakistan and the Institute of Tropical Medicine Belgium had enabled the latter to act as a supra national laboratory for TB Control in Pakistan. WHO was also technically supporting the USAID funded prevalence survey, and also assisting in incidence and drug resistance surveys to know the exact burden of the disease in Pakistan alongside efforts to detect and cure patients of tuberculosis. The current case detection rate of the programme was 69% while the treatment success rate was 92%.
The WHO representative in Pakistan Dr Ni’ma Saeed Abid had expressed satisfaction over the performance of the National and Provincial Tuberculosis Control Programmes and hoped that with an increased pace of effort, the Millennium Development Goal relating to Tuberculosis could at least be partially achieved by 2015. He emphasised that WHO had remained a consistent technical partner of the programme and had been supporting the programme particularly in the areas of monitoring and evaluation, resource mobilisation and operational research. He described tuberculosis control as one of the few success stories in Pakistan’s health sector.
Dr Abid described it as a fight both against the disease and time as the more the time that was lost, the more difficult it would be to control the disease with the additional risk of developing multi-drug resistant strains of tuberculosis. There was therefore no room for complacency in this regard, and a grand concerted effort was required to reach all the cases and provide them with quality treatment close to their doorsteps, while emphasising the preventive aspects as well.
Giving details of the programme’s performance, WHO’s National Professional Officer for Tuberculosis Control Dr Ghulam Nabi Kazi pointed out that in 2012 over 284,000 cases of Tuberculosis had been detected and placed on treatment while this year the figure would touch around 300,000. He pointed out that around 420,000 new cases appeared in the country every year.
As regards drug resistant tuberculosis or MDR-TB, Dr Kazi pointed out that the services of a regional MDR TB expert Dr Salem Barghout had been acquired to support the National TB Control Programme in the area of drug management, developing a community based model of MDR-TB care based on ethical considerations, capacity building and preparing a pragmatic expansion plan.
Currently twelve tertiary care institutions including Lady Reading Hospital Peshawar, Ayub Medical College Hospital Abbottabad, Gulab Devi Hospital Lahore, Mayo Hospital Lahore, Leprosy Hospital Rawalpindi, Nishtar Medical College Hospital Multan, Samli Hospital Murree, Ojha Institute of Chest Diseases Karachi, Indus Hospital Karachi, Ghulam Muhammad Mahar Hospital Sukkur, Institute of Chest Diseases Kotri and Fatima Jinnah Hospital Quetta are providing MDR-TB services and currently 1,100 patients have been enrolled on treatment for a period of two years or more. Thus far 600 patients have completed treatment. However, now with the medicines in place with GFATM support, the expansion plan was being developed to enrol over 3,000 patients every year.
Dr Kazi expressed the hope that the long delayed process of project approval and release of funds for TB control would be resolved soon at the federal and provincial levels enabling the public sector to meet the core requirements of the programme, and ensuring sustainability of the process without undue reliance on external agencies. It was time that the government translated its high level commitment in concrete terms and put the activities of the TB control mechanisms on an even keel, he said. Our deliberations with the Planning Commission, Ministry of Inter-Provincial Coordination, provincial Planning and Development and Health departments have been most positive thus far, he added.