The role of MRC Unit The Gambia in achieving the theme of ending tuberculosis

Tuberculosis (TB) is still a major global health problem. One of the key gaps in TB control is the ability to diagnose TB accurately and early. There is about 4 million patients who are missed each year – closing the gap requires research, dedication and community awareness of TB. According to Dr Abdou K Sillah, Research Clinician, ” it is important to emphasise that TB is treatable if detected early and is vital for reducing transmission to those closest to you. MRCG and the National Leprosy and Tuberculosis Control Program (NLTP) are working together to increase health seeking behaviour and reduce the stigma associated with TB in The Gambia.”

wtbd_cpWorld TB Day is celebrated on 24 March each year. The theme fo this year is Unite to End TB: Leave no one behind. This is an opportunity to raise awareness about the burden of tuberculosis worldwide and the status of TB prevention and care efforts. It is also an opportunity to mobilise political and social commitment for further progress in efforts to end TB.

1. Research in controlling tuberculosis

One of the major Sustainable Development Goals (SDG) is to end the TB epidemic by reducing the incidence of TB by 90% and mortality by 95% by 2035. Effective diagnosis and prompt treatment initiation of notified TB cases with improved research tools will be crucial in achieving this SDG.

The Tuberculosis Case Contact Platform (TBCC) at MRCG continues to perform vital research in discovery of tools for TB diagnosis and vaccines. It allows quality research for understanding the dynamics of TB infection, TB disease risk and risk of TB recurrence. It also provides insight into drug-resistant TB, a major concern for TB control programs.

It also allows discovery of new biomarkers for development of more effective vaccines to replace Bacillus Calmette–Guérin (BCG), which has been in existence for decades and remains the only licensed vaccine for TB.  Clearly, we need evidence-based determination of who to treat, how to treat, and how long to treat both for prevention and cure.

  1. Contact tracing:

For decades, contact tracing (CT) has served a key role in the control of TB and many other notifiable communicable diseases. Unfortunately, CT which is a labour-intensive and time-consuming process needing trained personnel to effectively carry out is not routinely conducted by TB control programmes in most part of the world.

National TB Control Programmes (NTPs) continue to experience delay in diagnosis which could lead to worsening of the disease, increases the risk of TB transmission to closed contacts and mortality.

Sustainable and effective contact tracing and screening remain essential to prevent secondary cases and are especially important for child contacts, given their greater susceptibility to severe forms of the disease and the missed opportunities in early diagnosis because of the paucity of trained skilled clinicians.

In fact, it has been stated that about half of the close contacts of an infectious patient will become infected and an untreated smear-positive case may infect an average of 10-20 individuals in two years. Contact tracing is important to establish the primary source of the TB disease and to detect all those who could have been infected and possibly diseased for prompt diagnosis and treatment.

Being cognisant of the important of contact tracing, the MRCG has screened thousands of child and adult TB contacts within the Greater Banjul Area and will not relent our efforts in finding the missing TB cases and promptly referred them for treatment.

  1. Isoniazid Prophylaxis:

The main purpose of preventive therapy is to prevent latent (asymptomatic) infection from progressing to clinical disease. Such therapy is also used to prevent initial infection and to prevent recurrence of past disease.

The appropriate use of preventive therapy will play a crucial role in efforts to eliminate tuberculosis in The Gambia. When taken as prescribed, isoniazid preventive therapy is highly effective in preventing latent tuberculosis infection from progressing to clinically apparent disease.

The Childhood TB Programme Grant at MRCG has been ensuring that childhood contacts of adult TB cases are put on Isoniazid chemoprophylaxis with very good coverage and adherence within our cohort. From our cascade of care, this has proved effective and we are yet to diagnose any TB case from those put on isonicotinylhydrazide (INH). This high coverage and good adherence was achieved through constant health education, monthly delivery of medication to participants, monitoring and good records keeping.

Isoniazid preventive therapy should not be initiated, if proper screening can identify those infected and exclude diseased patients cannot be guaranteed.

  1. Childhood tuberculosis

The burden of childhood TB is one of the indicators used for assessing the ongoing transmission of the disease within a community. The TB programmes should assess TB indicators (i.e presumptive cases, notification, TB/HIV, treatment outcomes) among childhood TB cases to provide essential evidence to help understand the effectiveness of TB control programmes and the disease burden. Though training frontline health care workers to increase confidence and ability to deal with sick children or families of people with tuberculosis to identify, manage and monitor children affected by tuberculosis is paramount in our efforts to preventing unnecessary deaths and suffering from the disease.

  1. Collaboration with the NLTP

The TBCC Platform at MRCG will continue to collaborate with the NLTP in their efforts to eliminating TB in The Gambia. The Unit has been providing diagnostic facility in terms of MDR-TB for GeneXpert and Drug Susceptibility Testing (DST), providing consumables for TB diagnosis and providing training for Leprosy and TB Inspectors (LTIs) and other health care workers in The Gambia. In turn, trained staff at all health clinics in the Greater Banjul Area are essential for sensitising and referring potential patients for MRCG studies. In this way new studies such as TB-Sequel, provide capacity building in a collaborative effort between MRCG, NPHL and NLTP.

  1. Community engagement strategies

To increase and maintain the awareness of TB through engagement of the local communities and the general public in The Gambia, MRCG and NLTP will hold a community event on Wednesday 29th March at the Semega Janneh Hall in Bundung.

The event will aim to provide the community with adequate information on tuberculosis and how they could participate in controlling the disease at the community level. The day-long event will also address the issue of stigmatisation during the celebrations, which TB patients face within the communities and how we could all unite to end it.

Our research focuses on TB cases and their contacts through a family centred approach. With the ultimate aim of achieving elimination of TB disease, the research helps to understand how TB is transmitted within communities, as well as how the diagnosis, treatment and control measures could be improved.