Dr. Ejaz Qadeer is a well-known and dynamic personality in the medical field. Currently he is working as National Program Manager, National TB Control Program (NTP), Islamabad. On the occasion of World TB Day 2011, Muhammad Fareed, Publisher & Managing Editor, ‘Medical Review’ got the opportunity to interview Dr. Ejaz Qadeer. Following are the excerpts of the Interview.
Q. World TB Day is commemorated every year, what is the objective of this day?
Answer: World TB Day, falling on March 24th each year, is commemorated every year throughout the world. This day is designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing the deaths of several million people each year, mostly in developing countries. March 24th commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. Koch’s discovery opened the way towards diagnosing and curing TB.
In order to commemorate this day, people from different walks of life including government officials, parliamentarians, donors, NGOs, bilateral and multilateral organizations, media, youth, TB Patients and other key stakeholders design and implement awareness raising and advocacy interventions in order to sensitize, motivate and encourage people to join hands in the fight against TB.
Q. What is the current situation of TB globally and in Pakistan?
Answer: Tuberculosis is the second most common cause of death from infectious diseases in the world, killing almost 2 million people annually. Nine million new cases of the disease are estimated to occur every year, more than 95% of these are in the developing countries. Furthermore, 80% of the cases occur amongst people in the most economically productive age group of 15-45 years, representing a major economic burden for patients and ultimately for countries.
The 22 countries referred to as high-burden countries account for 80% of the world’s total TB burden. Certain highly populous countries of Asia namely, India, China, Indonesia, Bangladesh and Pakistan, have the highest number of cases, and together account for more than half the global burden. The HIV pandemic has resulted in a dramatic increase in the number of cases and worsening of treatment outcomes. Multi Drug Resistant (MDR) TB also represents a major challenge for TB control.
Tuberculosis (TB) continues to be a major public health challenge in Pakistan also. Each year, an estimated 420,000 new patients add up to the country’s escalating TB burden. The Government of Pakistan is committed to meeting all health-associated targets embodied in the Millennium Development Goals (MDGs) and endorsed by the STOP TB Partnership. Pakistan reaffirmed its commitment to TB control in the Medium-Term Development Framework (MTDF) 2005-2010, a national plan guiding annual budgetary allocations for various sectors of the economy including health, and continues to mobilize additional resources to mount a coordinated response against the 100% curable disease.
Q. What efforts have been made so far by the National TB Control Program to prevent, control and treat TB?
Answer: One of the key milestones achieved in Pakistan’s fight against TB dates back to 2005, when the National TB Control Program (NTP), in partnership with its provincial counterparts, achieved 100% DOTS (Directly-Observed Treatment Short-Course) coverage in health facilities within the public sector health delivery system. This achievement demonstrated the country’s seriousness to reach the targets enshrined in the global Stop TB Strategy, which envisages detection of 70% of new sputum smear-positive TB cases and a treatment success rate of at least 85% Prior to that, the government responded to the rising burden of TB by declaring it a national public health emergency.
Other main achievements of the program include;
1. Number of TB cases diagnosed was increased from 20,707 in 2001 to 267,451 in 2009. Since the revival of the program in 2001, NTP has successfully treated more than 1.3 million TB cases free of cost. Current case detection rate of new smear positive TB cases is 75% and treatment success rate is 91%.
2. 5,800 diagnostic and treatment centers have been established in the public sector provide which are providing free TB testing and treatment services.
3. Resources has been secured for 50% requirement of TB drugs for next 5 years. Through Global Fund Round 8, NTP is establishing drug management system and refurbishing warehouses all over the country.
4. 1170 peripheral microscopy centers have been established all over the country and approximately 600,000 TB suspects are tested each year free of cost. In addition NTP has established and functionalized BSL-3 reference laboratory at National level. Five more BSL-3 labs will be established during this year in the provinces.
5. Joint Coordinating Board and National Technical Working Groups have been constituted for TB/HIV & MDR- TB under Federal Ministry of Health for policy guidelines to address these challenges.
6. MDR-TB management has been started at 3 pilot sites. Resources have been secured for comprehensive management of 15000 MDR-TB patients (diagnosis, treatment and social support).
7. Childhood and difficult to diagnose TB case management started through piloting in 30 DHQ hospitals and 27 tertiary care hospitals. Program is providing free pediatric drugs and Purified Protein Derivative (PPD).
8. National TB Control Program is spearheading on Public Private Partnership for sustainable solution to quality TB services in the country. A network of private and non-profit organization is involved in TB care. During 2009, 16% TB cases in national data were contributed through the PPM.
9. NTP has recently has established Stop TB Partnership Pakistan and designated a Stop TB Ambassador in Pakistan. Branding strategy is adopted for 5,800 health facilities. In addition awareness has been raised through electronic and print media.
10. NTP has a functional research unit which has linkages with national and international organizations. NTP is conducting a large country-wide TB Prevalence survey from 2010 to 2011 to estimate the exact burden of TB in the country.
Q. If TB is curable, why million of people die every year due to TB?
Answer: The main reasons owing to the death of millions of people due to TB are lack of awareness that TB is curable, lack of knowledge that TB diagnosis and treatment is available free of cost at government health facilities and lack of trained and skilled health care providers.
Q. Why is stigma attached with TB when it is curable?
Answer: People with TB often suffer from stigma and discrimination. As there is lack of knowledge and people do not know that TB is curable and also that they can save others by adopting simple measures like cover their mouth when they cough or sneeze etc. So in most of the cases the patients often isolate themselves to avoid infecting others and to avoid uncomfortable situations such as being shunned or becoming the subject of gossip.
Not only does stigma influence the risk of contracting and developing TB; at each step towards successful diagnosis and treatment, structures and barriers defined by stigma create disadvantages that are specific to women or men in different contexts. However stigma is mainly faced by women suffering from TB.
Q. Is there any link between TB & HIV?
Answer: Yes. TB is the earliest manifestation of AIDS in more than 50% of all cases and is one of the leading causes of death among people living with HIV. WHO estimates that more than 7 million people, 98% of who are in developing countries are co-infected with HIV and TB. TB adds to the burden of illness of HIV infected people and shortens their life expectancy while HIV epidemic spurs the spread of TB. HIV-positive patients are highly vulnerable to TB, because of their weakened immune systems. TB is also more difficult to diagnose and more complicated to treat among people who are HIV-positive; this leads to delays in treatment of TB and increased risk of spreading TB to other people. So far there is no accurate and effective diagnoses and treatment of TB-HIV co-infection, therefore people living with HIV need early diagnosis and treatment of TB. If TB is not present, they should receive TB preventive treatment. Similarly TB patients should complete DOTS treatment for preventing HIV.
Q. There is a global movement to stop TB known as Stop TB Partnership. Is there any such form/movement in Pakistan?
Answer: Yes, the Stop TB Partnership Pakistan has been established. The partnership is a non-governmental body registered as a trust and represented by National and Provincial TB Control Programs, TB patients, multilateral agencies, donors, media, private sector, academia and civil society organizations. This forum is chaired by the vice chancellor of Dow University of Health Sciences, Karachi.
The partnership serves as an indigenous means of resource mobilization and advocacy for TB control in Pakistan. The NTP provides technical support to the forum.
Q. At the end, I would request you to kindly give a message to the general public.
Answer: TB has no boundaries. All of us have to join hands to make Pakistan, a TB Free country. I would request all our partners, policy makers, decision makers, donors, media and TB Patients to come forward and play their part in fighting away TB.