Despite Reduction in TB Mortality Rates, Need for Comprehensive Care Remains

According to the recently released World Health Organization (WHO) Global Tuberculosis Report 2012, the latest information on the tuberculosis epidemic shows positive global care and treatment trends. The report notes that the Millennium Development Goal of reversing the TB epidemic has been reached, and that new rates of TB infection fell by 2.2% between 2010 and 2011. As a result, it concludes that countries are on track to reduce TB mortality to 50% by 2015.

Despite these positives, the report recognized that the global burden of TB remains enormous, with 8.7 million new cases in 2011, of which 13% were co-infected with HIV.  Additionally, it cautions that the global trends conceal changes at the regional level, stating that Africa and some European regions are not on track to halve morality in three years’ time.  And although access to TB care has expanded substantially since the mid-1990s following the launch of the WHO-TB strategy, the report finds that progress in responding to multi-drug resistant (MDR)-TB remains slow.

Indeed, literature shows that health implementers in high TB-endemic areas with limited resources have been struggling with TB control for many years, primarily due to the lack of a rapid and reliable diagnostic test for HIV-associated TB and MDR-TB.  Many questions have arisen, and expert meetings have been held, around how best to integrate MDR-TB management into existing TB diagnostic tools, and around the care and management of MDR-TB patients. 

The palliative care community has been at the forefront in creating useful frameworks that can guide program development and address these questions. Palliative care experts in South Africa – with leadership from the Hospice Palliative Care Association of South Africa, and drawing on resources from the WHO STOP TB Initiative, the South African Department of Health TB control guidelines, as well as training material from the Center for Disease Control – have produced comprehensive guidelines for providing palliative care to patients with TB.

With financial support from the International Palliative Care Initiative of the Open Society Foundations, these guidelines have been translated into Armenian, French, Georgian, Portuguese, Russian, Ukrainian and Vietnamese in order to support program development in many countries. (For copies of the translations, please contact the Public Health Program.) The guidelines recognize that management of MDR-TB is a multifaceted enterprise, requiring effective planning for screening and diagnosis, complex drug management, individually supervised treatment, psychosocial support to patients and their families, and extensive monitoring and evaluation.  As organizations in resource-limited settings scale up their MDR-TB services, these guidelines offer a vital resource for supporting the development of palliative care.