To raise awareness and help combat tuberculosis (TB) in The Gambia, the TB team from MRC Unit The Gambia joined the Gambian Government, the National Leprosy and TB Control Programme (NLTP) and the communities around Mandinary on 23 March for a ceremony to commemorate the World TB Day 2015. The ceremony was followed by a National TB program broadcast on 24 March.
TB remains a serious cause of illness and death in many countries. World TB Day is celebrated worldwide on 24 March to remember those affected by TB anywhere. Every year 9 million people are infected with TB; of that number, 3 million don’t get the care and treatment required and 1.5 million die, amongst them 70,000 children.
Around 600 people, including school children, attended the ceremony which included speeches by the Theme Leader for Vaccines and Immunity and program leader for the childhood TB research at the MRC Unit The Gambia, Professor Beate Kampmann, MRC research clinician from the childhood TB Programme Dr Abdou K Sillah, and Mustapha Sima, a representative from the Regional Directorate of Health.
The participation of communities in World TB Day is particularly important in efforts to reduce stigma and educate all people on the importance of seeking early treatment. Activities included a march past led by a scout band, a TB drama production by the Kanyalen Group and a knowledge quiz about TB, with prizes awarded for the right answers.
At the ceremony, Professor Beate Kampmann explained: “The MRC is contributing to the global ceremony together with the Government of The Gambia in an effort to combat TB which is a major health issue affecting millions of people annually”.
Dr Abdou K Sillah said: “World TB Day is important in the sense that the WHO and the world at large have realised that a significant number of people are dying from a disease which is in fact curable. Everyone has an obligation to help people receive treatment and reduce the transmission of the disease to the wider communities.”
Representing the Regional Directorate of Health, Mustapha Sima spoke extensively on attitudes towards TB in The Gambia and urged people to be mindful of alternate treatments said to cure TB which may have significant negative consequences.
The MRC and the National Leprosy and TB Control Programme recently conducted the Gambia Survey of TB Prevalence (GAMSTEP) and TB Knowledge, Attitude and Practice Survey (TB-KAP) funded by the Global Fund, which showed a drop in the number of TB cases in the community. As a result of this survey, the next strategy can now be derived to tackle TB.
TB research at MRC Unit The Gambia is well supported by this year’s Stop TB Partnership motto of ‘Find. Treat. Cure TB’; details of some current projects are highlighted below.
Currently only 16 per cent of adult TB cases have a confirmed TB diagnosis, largely due to lack of access to healthcare facilities and lack of knowledge about seeking treatment at an early stage. Adults with smear positive TB transmit the TB bacteria to close contacts, including children. Early treatment initiation is important in reducing the transmission cycle.
“The MRC TB case-contact (TBCC) platform has been key in promoting community education to family members of adult TB patients to reduce the stigma associated with TB diagnosis,” said Dr Jayne Sutherland, Head of TB Immunology and the TBCC. “Funding from the MRC, the Gates Foundation and EDCTP has been crucial in development of new diagnostic tests for use at basic health clinics, where the majority of patients present with TB.”
Current research has shown that children have a much higher burden of TB than previously believed. However recognition of childhood TB remains a challenge. By integrating data from epidemiology, molecular biology and immune signatures derived from children in household cohorts, development of a novel “toolbox” for the understanding of childhood TB is in progress, funded by an MRC programme grant.
Funding from the Stop TB Partnership’s TB REACH programme provided the foundations for The Unit’s Reach4kids programme, a long-term effort to find and treat children with TB in The Gambia. The MRC team has developed a specialised training package in childhood TB to enable identification of suspected child TB cases and appropriate management. The aim of the training is to increase detection of childhood TB.
“MRC Unit The Gambia is working closely with the Gambian Government and the NLTP to evaluate new diagnostics like the GenXpert. If we can improve the diagnosis in adults and children, the NLTP can then put all those people on treatment, as they provide the TB drugs for our patients,” said Beate.
“We are also fortunate in The Gambia that drug-resistance is still relatively low. However, the MRC and NLTP must work together to ensure drug-resistance does not increase. The cost of treating one patient for drug-resistant TB is equivalent to 1000 with drug-sensitive TB. Prevention and education are of key economic importance.
“In line with the WHO recommendations, the MRC TB Programme recommends giving medications to children living with TB patients to prevent them from contracting TB, as people living with TB patients are at a higher risk of contracting the disease. We have pioneered this in the Gambia through our research program, and we are now in a position to assess its feasibility with the NLTP.”
It is important to remember that anyone with TB can be cured, if they get diagnosed and treated with the right drugs in good time. However, one of the major problems with TB is the lack of a fully protective vaccine. Challenges in developing such a vaccine are associated with many factors, including a lack of understanding of how our immune system protects us against TB.
Jayne recently secured a European grant to work on TBVAC2020. Termed ‘correlates of protection’, the main aim of TBVAC2020 is to define protective immune responses in animal and human models and to innovate and diversify the current TB vaccine and biomarker pipeline.
Using The Unit’s unique TBCC platform, the team is analysing samples from family members exposed to TB patients in order to determine which parts of the immune system protect them from infection and ultimately disease.
“In order to combat TB, a health systems approach is required with a triangle consisting of the MRC, NLTP and the Gambian community. By working together, we aim to find, treat and cure TB and therefore significantly reduce the number of TB-related mortalities by 2020,” said Jayne.