Medical Ethics and Human Rights Together can Eliminate TB by 2030

Highlights:

• Upholding the principles of medical ethics and providing effective and accessible treatment to all persons with active disease as well as latent disease is essential for the prevention and control of TB
• TB is the biggest killer infection globally. Every year 10 million new cases are diagnosed and about 1.6 million deaths occur, related to TB, of which 300,000 deaths occur in HIV infected persons. At least a quarter of the world’s population is estimated to have latent TB
• With the incidence of TB going up in the immunosuppressed group (e.g: patients with HIV infection) and the emergence of drug resistance, control of tuberculosis is a major health challenge that needs to be urgently addressed

Eradicating tuberculosis (TB) is impossible unless both active and latent cases are treated effectively. Governments across the world and healthcare systems must provide affordable and effective treatment to both patients and others at high risk, and uphold the principles of medical ethics and human rights which calls for right to treatment for all.

Tuberculosis Preventive Therapy (TPT) is a Better Option

Although TB can be prevented as well as effectively treated TB can be prevented as well as effectively treated Ending Tuberculosis with Preventive Therapy, several million cases are diagnosed every year with a significant proportion of TB related deaths. Optimal, and affordable treatment must be made accessible to all, including those with latent TB, who makeup nearly a fourth of the world’s population and form a high-risk group in whom TB has to be prevented.

According to Prof Harry Hausler, Chief Executive Officer of TB HIV Care in South Africa, “TB preventive therapy (TPT) has been around for a long time but its rollout has been suboptimal. South Africa is a country that has the biggest implementation of TB preventive therapy as well as antiretroviral treatment in the world. More than 400,000 people on TB preventive therapy were initiated last year but that’s still 53% of people who are newly enrolled in HIV Know More About HIV care. We have another 4.4 million South Africans living with HIV who are already on antiretroviral treatment, but we do not have data to say what proportion of them have access to TB preventive therapy. So, we really do have a long way to go.”

Four Pillars of Medical Ethics Help Eliminate TB

• Beneficence – Doing What is Beneficial
Giving treatment that is beneficial to the person. In this context, the prevention of TB is important. TB preventive treatment is effective and currently, several options are available such as six months of isoniazid (INH) therapy; and new treatment regimens as per the latest WHO guidelines, namely 3 months of weekly rifapentine and INH which is as effective as three months of rifampicin and INH.

• Non-maleficence – Doing No Harm
The new regimen namely 3HP is less toxic to the liver and thus safer, and patient compliance is also likely to be better and to complete treatment than six months of isoniazid (INH).

3HP is one of four regimens that Centers for Disease Control and Prevention (CDC) recommends to treat latent tuberculosis infection treat latent tuberculosis infection Shorter Treatment Regime to Cure Latent Tuberculosis. The term 3HP is derived from the length of treatment (once weekly doses for3 months) and letters from the abbreviations of the two drugs (INH and RPT), that make up the regimen. It is also referred to as the 12 dose regimen.

Esnath Manhiri from Zimbabwe national network of people living with HIV, said: "People living with HIV are at very high risk of getting infected by TB. My message for people living with HIV is that let’s go for TB Preventive Therapy (TPT). This new TPT regimen is very short, has less side effects and the treatment completion rate is very high. Let us encourage each other to go for TPT so that we can prevent ourselves from getting infected by TB."

• Autonomy and Justice
People should have the right to choose the regimen that they want, and justice because rifapentine at the current price is not affordable to many. Pharmaceutical companies must be urged to bring down the price of rifapentine and make it accessible to all, especially in high burden countries of Africa including South Africa.
• Political Will and Governmental Support
All countries signed a political declaration in September 2018 at the United Nations High-Level Meeting (UNHLM), pledging to bring 30 million people on TB preventive treatment (TPT) by 2022, which includes 6 million HIV patients, 20 million household contacts and 4 million children under five years of age.

Dr. Suvanand Sahu, Deputy Executive Director, Stop TB Partnership, said that the three key factors to focus upon to making prevention of TB successful include:

• Raising available domestic resources, particularly in high TB burden nations
• Identifying persons overlooked in the past
• Making heads of countries accountable, politicians and leaders answerable for the implementation of preventive measures and achievement of targets

In summary, eliminating TB poses a huge challenge and governments, health workers, patients and the public must all come together and make this ethically driven campaign a success and achieve tuberculosis eradication by 2030.

Reference:

1. 3HP FAQs for Providers - (https://www.cdc.gov/tb/education/FAQforProviders.htm)

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Source- Bobby Ramakant, CNS (Citizen News Service)