Equitable access to treatment can end tuberculosis
By Dr. Heejune Chang
Winnipeg Regional Health Authority
Published Monday, March 20, 2023
When we hear about tuberculosis, more commonly known as TB, many of us might think of it as a disease of the past.
The reality is that TB remains one of the world's most devastating infectious diseases – according to the World Health Organization, in 2021, an estimated 10.6 million people fell ill with TB, and 1.6 million people died of TB. Globally, it has been the top cause of death due to a single infectious agent every year until it was surpassed by COVID-19 in 2020 and 2021. And it remains cause for concern in Canada and in Manitoba – in 2022, Manitoba reported 195 individuals newly diagnosed with TB.
Every year, March 24th marks World Tuberculosis Day, an annual campaign led by the World Health Organization to raise awareness about TB, as well as highlight the worldwide commitment to eliminate tuberculosis by ensuring equitable access to prevention, treatment and care for this disease.
So, what is TB? It is a serious disease caused by bacteria called Myobacterium tuberculosis. TB most often affects the lungs, but can also develop in any other part of the body such as the lymph nodes, kidneys, bones, spine or brain. Symptoms can include cough, fever, night sweats or unexplained weight loss, and may start mild, but will progress to serious disease and death if not diagnosed and treated.
Despite the development of effective antibiotics against TB in the 1940s, TB disease persists, in large part due to the challenges of providing appropriate care, but also because many of the social improvements that have led to dramatic reduction in TB rates in some parts of the globe since the mid-20th century have not been equally distributed.
Transmission of TB is airborne; those with TB disease in the lungs spread the bacteria when they breathe, cough, or speak. Unlike highly contagious diseases such as COVID-19 or measles, becoming infected with TB often takes weeks to months of repeated exposure to a person with untreated infectious TB. As a result, transmission of TB is greater in settings of overcrowded housing, and is associated with other determinants of health that can increase risk of TB disease, including poverty, malnutrition and chronic diseases.
While for most people living in Canada, the risk of acquiring active TB is very low, rates of TB have remained significant among Indigenous peoples, reflecting historical and ongoing inequities this population faces.
Recent history has also shown that unexpected factors can impact treatment tools which then in turn affect our ability to reduce TB rates. The global persistence of TB has led to rising strains of antibiotic-resistant TB, and more worryingly, multidrug-resistant TB which does not respond to the usual TB antibiotics and is extremely challenging and costly to treat. In the 1980s, with the emergence of HIV, HIV/TB arose as a deadly combination, forcing a reset to the approaches used to treat TB and move towards more concerted action in bringing down tuberculosis numbers. Then in 2020, the COVID-19 pandemic coincided with an increase in global numbers of deaths due to TB for the first time in over 10 years, likely due to diversion of TB resources to efforts addressing the pandemic.
Tuberculosis is preventable, treatable and curable. Early identification and diagnosis are best for positive outcomes for those affected by TB. Once diagnosed and receiving treatment, good health care and social supports throughout the treatment period are key to ensuring patients complete treatment successfully.
This is the focus of the work of the Tuberculosis Public Health Team within the Winnipeg Health Region. We work with people affected by Tuberculosis, their families and their other health care providers within an integrated framework, supporting them in their homes, in the community and in hospital from the time of their diagnosis to the end of their treatment.
As the theme of World TB Day 2023 states: Yes, we can end TB. But only by working together to ensure everyone in Manitoba, Canada and the world has equitable access to care and treatment, and addressing the inequities that contribute to the persistence of this disease.
Dr. Heejune Chang is a Public Health & Preventative Medicine Physician with the Winnipeg Regional Health Authority.
