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Gavin Churchyard (MBBCh, MMED (Int Med), FCP (SA), FRCP (Edin), PhD) is a specialist physician, internationally renowned for his contributions in TB research. He recently gave a Union webinar: TB preventive therapy: recent advances and future prospects. Here he writes his thoughts on TB prevention during COVID-19…
In all the political hearings, scientific papers and media coverage examining the COVID-19 pandemic, a common undercurrent is how so much of the infection could have been prevented. Whether the conversation touches on accurate case reporting, the timing of preventive measures, or even the funding of pre-pandemic planning, the world is collectively wringing its hands at the carnage that COVID-19 has been generating around the world and wondering if it all could have been avoided.
The COVID-19 pandemic is also impacting TB programmes. In order to minimise the impact of COVID-19 on the TB epidemic, we must continue providing TB prevention, care and treatment to those in need. Taking TB medicines and completing treatment will not only cure TB but will also improve the body’s ability to fight other infections, including COVID-19. Yet, prolonged disruptions—in pharmaceutical production capacity in countries under lockdown and in international and local transportation—have been impacting the stocks of medicines and laboratory supplies needed to prevent and treat TB.
As opposed to COVID-19, we have drugs to prevent TB. Research continues to show the effectiveness of a short-course three-month regimen for people at high risk of developing active disease, including those living with HIV. The regimen, consisting of weekly doses of rifapentine and isoniazid for three months (known as 3HP), which provides lasting protection. The Aurum Institute, through Unitaid’s support, is leading a consortium of partners under the IMPAACT4TB project. Across 12 high-burden countries, representing 50 percent of the global TB burden, our team is helping national TB programmes to prioritise short-course TB preventive therapy for people living with HIV and children under five, and subsequently all those in close contact with people with TB.
Since March 2020, restrictions related to COVID-19 have made efforts to deliver 3HP treatments in 12 countries challenging. In some countries, TB prevention was not identified as an essential service, curtailing our ability to reach those in need. In other cases, reductions in production capacity for 3HP, coupled with reductions in international transport, have slowed down availability of 3HP. Moreover, with fewer people coming to health facilities for care, fewer are being enrolled into TB prevention programmes.
Amplifying community voices to scale-up short-course preventive therapy for TB
As countries struggled to maintain TB and HIV services during COVID-19 lockdowns, civil society groups applied pressure to make sure that TB preventive therapy services were not stopped, but rather adapted to COVID-19 so that scale-up could continue.
Meaningful involvement of communities and working closely with their supporting systems improves the uptake of health services. TB preventive therapy can be integrated into differentiated service delivery models to enhance treatment adherence and completion rates. Strengthening these community systems and integrating TB preventive therapy into differentiated service delivery models will only become more important as our countries seek to scale-up TB preventive therapy while confronting COVID-19. However, it should not be a question of TB or COVID-19? We must find a way to deal with both, and to continue efforts against other diseases of poverty, including HIV/AIDS and malaria.
TB may not have as dramatic a presentation as COVID-19, but it should not be ignored. TB accounts for many more deaths than COVID-19 and diverting resources away from TB treatment is simply the wrong approach. Instead, we should build on the lessons we have learned from TB outreach to inform our COVID-19 response and integrate TB preventive therapy and other TB programme activities into our COVID-19 response.
In recent years, we have made some precious gains in the fight against TB. When the smoke clears from this latest contagion, we need to make sure we have not lost ground in the fight to end the TB epidemic. Too many lives are on the line for us to toss TB prevention by the wayside.