24 Mar 2023
Ending the global tuberculosis epidemic
TB occurs in every part of the world and remains a major public health challenge that we can end through concerted action.
Nestled in the last week of March is World Tuberculosis (TB) Day. At 41 years old, 24 March remains a valuable opportunity to educate and galvanise responses to end TB.
Tuberculosis is an infectious disease caused by a bacteria which can damage the lungs or other parts of the body. It includes a range of symptoms such as coughing, chest pain, weight loss and weakness, fever and night sweats.
Since 2000, 74 million lives have been saved by global efforts to end TB, yet this preventable and curable infection remains a leading cause of death.
In 2021, an estimated 10.6 million people feel ill with TB, of these 1.6 million died.
“With the evolution of the COVID-19 pandemic, TB is once again the leading cause of death from a single infectious agent,” says Professor Justin Denholm, Medical Director of the Victorian Tuberculosis Program.
The risk factors listed by the World Health Organization (WHO) includes diabetes, smoking, alcohol disorders, HIV, and undernourishment – of these, undernourishment is the most prevalent factor in illness and death.
Tuberculosis continues to cost lives, livelihoods and lifestyles for millions.
More than 140 years after German physician Dr Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis in 1882, we’re still working to end this public health challenge.
World TB Day calls for renewed efforts to embrace the End TB strategy and adapt it to changed local settings following the devastating impact of COVID-19.
Realising the End TB Strategy requires harnessing the collective power of a community committed to a world free of TB and pushing for the application of integrated, person-centred care and prevention, alongside discovery, innovation and policy.
The power of person-centred care
Person-centred care – which treats each person respectfully as an individual human being, and not just as a condition – is recognised as a foundation to high-quality health care.
This approach acknowledges that being affected by TB is just one small attribute in a lifespan of experience and lived circumstances, and it invites practitioners to be curious about the person and build treatments with them, not for them.
It means working together to understand options and make decisions based on lifestyle and practicalities that are informed by values, as well as an understanding of the responsibilities that active and infectious TB brings.
The End TB Strategy, and subsequent publications, recognise that greater involvement by those affected by TB produces better health outcomes.
There’s a growing body of evidence that person-centred care improves experience and, as a result, engagement with health care. It’s argued that this relational practice results in reduced economic burden, and increased provider satisfaction and care experiences.
For the treatment of TB disease, lessons from other health care settings indicate that communication that’s free of stigma and bias can translate to less treatment interruptions and consequential complications.
This strategy also indicates that there’s an increased uptake of preventative treatment to help mitigate the risk of developing active TB following infection and increased capacity to remain engaged with long treatment periods.
Person-centred care principles can be used in practice across the health care system, including at the point of care, during service design and delivery and at the organisational or regulatory level.
World TB Day is an opportunity to examine what person-centred care looks like in the response to TB.
The words used to describe people and their behaviours are closely linked to self-image and identity. The adoption of a contemporary language guide is a strategic feature of a person-centred care approach to end hardships associated with stigma and bias due to TB.
The Stop TB Partnership’s Words Matter is a language guide than can be adopted across all levels of health care delivery.
Changing language and behaviours changes mindsets and helps eliminate barriers to participation in health care.
When it comes to infectious diseases, the language of surveillance for the purpose of control and the historically biomedical approach can undermine trust and disproportionately affect some populations.
Shared language that recognises people affected by TB as whole, more than a condition, empowers.
The public health burden of TB can be significantly reduced by universal access to high-quality TB diagnosis and treatment, social protection and general socioeconomic development.
But this is not likely to be enough if we do not have the shared language to apply this to everyone.
World TB Day is an opportunity to inspire, educate, and commune. To remember the lives lost and celebrate those saved.
Initiated by the current executive – Associate Sarah Dunstan, Professor Justin Denholm, Associate Professor Suman Majumdar, Dr Anna Coussens and Dr Khai Huang – the Melbourne TB Community (MTBC) seeks a collaborative platform for all involved in the response to TB. The MTBC spans research, public health, clinical care and community involvement.
This article was first published in Pursuit.