In the global response to tuberculosis, all care providers need to
be engaged, Gargioni stresses. "In countries like India, you see that the state
sector alone will find it very challenging to reach all people, even though many
persons choose to consult first with private practitioners," he says.
"The private sector with nongovernmental and faith-based organizations
can join efforts with the national programs to implement TB control plans. And national
programs can help mobilize resources to support initiatives of public utility that
come from the nonstate sector. This is the basic concept of national Stop TB partnerships."
These partnerships may be especially relevant in Asia, particularly
"in places where there is even some stigma attached to the public sector and
people think going there is something only the poor do," Gargioni illustrated
at the sideline of the international symposium "Research and development of
new tuberculosis vaccines" in Zaragoza, Spain (June 3-4). "It is important
to recognize this specific situation when addressing tuberculosis issues: this means
availing proper diagnosis and care based on international standards wherever people
will decide to seek medical attention."
The International standards for Tuberculosis (TB) Care and certifications
for private practitioners who follow them give some guarantee about the quality
of their work and of their collaboration with national TB programs, Gargioni adds.
"Moreover, WHO (World Health Organization) tuberculosis epidemiological data
come from case reporting by public health systems and, unless they also includes
information of the private sector, might then not fully reflect the situation."
The establishment of (more) public-private partnerships can play
an important role in facing these challenges, Gargioni says. "We're looking
at the private sector not as a problem, but as a resource," he stresses. "If
the private and public sector establish partnerships this can improve access to
diagnosis for thousands of sufferers, ensure quality of care and make the data we
have on the global tuberculosis epidemic more accurate."
Not only health care providers, also communities have to get more
involved. "Communities could and should play a decisive role, particularly
in tuberculosis detection by referring to health facilities people with chronic
respiratory symptoms and supporting patients during their treatment," Gargioni
says. "But communities are often completely unaware of the TB problem and not
involved in a dialogue to shape successful strategies at grass-roots level."
In a presentation at the symposium in Zaragoza, Gargioni presented
an overview of the global achievements and challenges in TB control and research.
Incidence rates are highest in Africa. "But in terms of absolute number of
cases, more than half are in the Southeast Asian and Western Pacific region,"
he said.
Of special concern in the Asian region are drug-resistant forms of
tuberculosis, which are even more difficult to treat. "Multidrug-resistant
(MDR) TB is a serious problem in China and in countries of the former Soviet Union.
The Indian subcontinent also shows an important role in the estimated absolute numbers
of MDR cases," Gargioni stressed. "Extensively drug-resistant TB (XDR-TB)
has unfortunately been detected in all countries where public health officials have
looked for it."
Weak health systems are a major challenge in efforts to control tuberculosis
in general, and MDR-TB in particular. "Problem No. 1 is the crisis in the health
work force. There are not enough people on the ground, to be close to where the
TB patients live and make care accessible," Gargioni said, adding that more
laboratories, improved infection control and more financial resources are needed
as well. "If we concentrate the efforts to control MDR-TB in India, China and
the Russian Federation, we can make a significant difference."
Thanks to the implementation of the DOTS (directly observed treatment,
short course) and Stop TB Strategy 36 million people have been successfully treated
from 1995 to 2008 and more than 6 million deaths have been averted, according to
WHO. But the challenges ahead remain huge. The latest WHO data show there are 9.4
million new TB cases and almost 2 million people deaths in 2008. Worldwide, almost
1,5 million people are TB/HIV co-infected, of which almost 0.5 million die every
year. In 2008, there were 440,000 new MDR-TB cases and 150,000 MDR-TB related deaths.
The two-day symposium (June 3-4) was organized by the University
of Zaragoza, the foundation Ramon Areces and TuBerculosis Vaccine Initiative (TBVI).
(CNS)
