World Tuberculosis Day: A Call To Action

WHAT IS TUBERCULOSIS?
Tuberculosis or “TB” is a treatable contagious disease that usually infects the lungs. It is caused by Mycobacterium tuberculosis bacilli and it can also be seen in the brain, skin, and other body organs. It is prevalent in densely populated countries such as China, India, Indonesia, and the Philippines.

WHAT’S GOING ON HERE?
The World Health Organization (WHO) recommends combination therapy of 2-4 drugs as the gold standard treatment for TB over a period of six months. mClinica’s data in 2016 revealed that in the Philippines and Indonesia, the percentage of transactions consisting of single drug or wrong combination of drugs is 35% and 47% respectively. These transactions are inconsistent with current recommendations from the WHO.

WHAT DOES THIS MEAN?
Under-treating with a single drug regimen or with the wrong combination of drugs will fuel the rise of the “super bug” multi-drug resistant tuberculosis (MDR-TB). This means that previously effective treatments may no longer work for MDR-TB. Currently, there are only a few options for effective second line drug regimens. In 2015 alone, WHO reported 17,000 rifampicin and multi-drug resistant tuberculosis cases in the Philippines. The number of cases was reported to be 10,000 in Indonesia for the same year.

WHY DOES THE PROBLEM EXIST?
Effective treatment is available and is given free by the government, but the problem exists because of the presence of “missed cases.” Missed cases are defined as TB patients not formally diagnosed by a physician or those lost to follow-up. Since they are not treated completely and they continue to infect other people; thus, fueling the spread and development of drug resistant cases. For both countries, estimated TB incidence for 2015 is much higher than the actual cases identified. This difference gives us the closest estimate of “missed cases.” This difference amounts to 38,000 cases for the Philippines and an alarming 690,000 cases in Indonesia.

WHY DOES IT CONCERN YOU?
The bigger picture:
Treatment for MDR-TB is costly and should be taken for at least 12 months. In worst cases, no effective treatment is available. In countries where TB is common and the crowding index is high, all cases should be identified and treated as soon as possible.
For the government:
Cases should be diagnosed immediately and treated adequately. In the Philippines, the government should strengthen implementation of key provisions of the new 2016 TB Elimination Law (R.A. 10767) such as the “no prescription, no anti-TB drugs” and mandatory reporting, especially in the private sector. On the other hand, Indonesia should fast track implementation of its new “Ministerial Decree on Tuberculosis,” signed on February 2017, which also emphasized mandatory reporting. Indeed, the “Stop TB” goal of reducing new TB cases by 80% in 2030 can only be achieved with strict implementation of these policies.

mClinica is on the front lines of the surveillance of diseases such as TB using its mobile technology platforms. Contact us at [email protected] for more information about our technologies or our research

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