Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. The TB kills around 10,000 Afghans in a year. The TB diagnosis and treatment is freely available in anywhere in Afghanistan.

The world health organization (WHO) estimates in its global TB report for 2018 that Afghanistan hosts 70,000 incidence number of TB cases of all forms and 2,500 TB cases of drug resistance TB. The Afghanistan notified 52,773 TB cases of all forms and 496 drug resistance TB cases in 2019. The unique phenomenon existed in Afghanistan is that there is higher proportion of TB among female than men. The Afghanistan had steady increase in TB case notification over the past decade.

Impact of COVID-19 on TB. The Imperial college London estimates that COVID-19 may affect TB, HIV/AIDS and Malaria program across the globe that will lead to higher death rate over the five years and may reached to 20% , 10% and 36% higher death rate for TB, HIV/AIDS and Malaria, respectively. In Afghanistan, it is estimated that circumstances owing to TB may lead to decline in TB case notification and treatment interruption. There are 5,000 less TB cases during first two quarter of 2020 compared to same quarters of 2019. On Sep 22nd, 2020, WHO asked for integration of COVID-19 case findings in TB services. Afghanistan already started this collaboration and cooperation through issuing a policy brief on reducing impact of COVID-19 on TB. The impact of COVID-19 on treatment could be found in the study on COVID-19 -Tuberculosis interactions: When dark forces collide. COVID-19: Outcomes of patients with confirmed COVID-19 re-admitted to hospital. Also, the Hindustan Times has published an article on the impact of COVID-19 on TB in India. You can find it here.

READ’s Expertise in TB: The experts volunteers to work for READ had sufficient expertise to implement large and small TB projects in Afghanistan. Majority of them had worked for more than 10 years in this field with national TB control programs or other development organizations. Also, they produced sufficient documentation in TB from Afghanistan that published in international conferences and journals such as international world conferences on TB and lung health (The Union) and journals like PLOS ONE, WHO’s Eastern Meditranian Journal and international journal of infectious diseases.

The READ organization has launched the social media campaign to increase the awareness on TB and other lung health issues. The aim was to deliver the right messages to community and to advocate for TB.

The READ organization is committed to contribute to the End TB Strategy. This strategy was developed by the World Health Organization (WHO) and aims to provide strategic direction to the world to achieve the goal of ending the global TB epidemic and objectives of 95% reduction in TB deaths by 2035 compared to baseline of 2015, 90% reduction in TB incidence by 2035 compared to 2015 and Zero TB affected families facing catastrophic cost due to TB be 2035. Find below the progress toward the targets in End TB Strategy

TB among children: Children are vulnerable to TB. The children age <15 year makes 11% of all TB cases notified in 2018. However, Afghanistan is different and in 2019 the children made 22% of all TB cases. Therefore, there is urgent need to improve the quality of TB care particularly diagnosis of TB among children. The READ organization advocate for TB and would promote the use of molecular technology such as GeneXpert and CAD4TB to diagnose TB among children. One of the approach the READ promoting is the stool test to diagnose TB among children using GeneXpert test and Ultra Cartridges. There are some evidences in the world that hypothesize this approach that could be found here. 1) Stool Xpert^® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe, 2) Effective testing for pulmonary tuberculosis using Xpert MTB/RIF assay for stool specimens in immunocompetent Pakistani children and 3) Stool Xpert MTB/RIF and urine lipoarabinomannan for the diagnosis of tuberculosis in hospitalized HIV-infected children

Digital Technology in TB diagnosis and treatment: 1) GeneXpert: this technology first invented and used to diagnose TB in 2010 and WHO recommends countries to use GeneXpert technology as initial diagnostic tool. The GeneXpert has highest sensitivity and specificity to detect TB from sputum specimen and other body fluids. This technology diagnose drug susceptible and drug resistance TB in two hours. There is new cartridges call Ultra and it diagnose it in one hour. The Cepheid the owner of GeneXpert technology has produced new Xpert MTB/XDR cartridge that can detect resistance to first and second line TB drugs. In addition, this technology can diagnose SARS-COV-2 virus and other viruses such as HIV, HBS, HBC etc.

TB resources: 1) WHO Global TB report 2019, 2) World Health Organization. Consolidated guidelines on drug-resistant tuberculosis treatment, 3) Key facts about TB, 4) Recommendation on contact investigation of a person with infectious tuberculosis, 5) Comprehensive guidelines for TB program, 6) INDEX: TB guidelines for Extrapulmonary TB, 7) A human right approach to TB, 8) International Standards of Tuberculosis Care (ISTC), 9) Global TB report 2020

Updates: The WHO released the Global TB report for 2020 and states that 1.8 million individuals will die of TB in current year, the level, same as in 2012. In 2019, 1.4 million people died of TB. Potential reasons for the decline include people’s avoidance of health facilities, reductions in the number of health facilities offering TB diagnostic and treatment services, disruptions in the procurement and transportation of medicines and other laboratory items, movement restrictions, and loss of income. In some cases, there were concerns of TB patients being suspected of having COVID-19, given some similarities in symptoms between the two diseases such as fever and cough, and delays in data recording and reporting. The economic costs of non-adherence to TB medicines due to loss to follow-up and stock-outs represent a significant economic burden for the country and it is likely that the cost of addressing these problems would be much less than this burden and, therefore, a wise investment. There is an independent association between vitamin D deficiency and progression from latent TB infection to active disease. In community-wide screening for TB, CXR is more sensitive than a single spontaneously expectorated sputum sample tested using Xpert, but it has a substantially lower participation rate. Length of Stay (LOS) in hospital was related to TB type, comorbidities and hospital location. Promoting outpatient care is a priority to improve TB management in Switzerland. Vitamin D deficiency predicts latent TB reactivation independent of preventive therapy: a longitudinal study. Vitamin D deficiency is associated with progression of latent tuberculosis (TB) infection to active disease. Of 1509 latently infected individuals with 3902 patient-years of follow-up, 687 (45.5%) were identified as vitamin D deficient and 691 (45.8%) individuals had a LTBI regimen prescribed. There were 29 (1.9%) instances of TB reactivation. The economic costs of non-adherence to TB medicines due to loss to follow-up and stock-outs represent a significant economic burden and cost to address this challenge would be much less, therefore, a wise investment.

TB and COVID-19 Considering the mutual and common signs and symptoms of TB and COVID-19, there is need to strengthen and expand the cooperation and collaboration between these two programs. The screening of TB patients for COVID-19 and COVID-19 for TB or screening of individuals presumptive to have either of the disease could lead to early detection of TB and COVID-19 patients. For details, refer to guidance note on Bi-directional TB-COVID screening and screening of TB among ILI/SARI cases. Similarities of TB and COVID-19: The international Journal of TB and Lung Disease (IJTLD) has published the editorial titled TB and the COVID-19 pandemic: brothers inarms against lung health. This utmost important editorial elaborates the cooperation and collaboration between TB and COVID-19. The biggest shift in TB care in decades’: Tuberculosis treatment time reduced by a third: