The transformative power of data to diagnose, treat and prevent TB
Message from the Executive Director, 29 April 2020
Like many of us in the global health community, I am increasingly concerned by the potential impact of COVID-19 on people affected by tuberculosis (TB), many of whom will likely face difficulties accessing the care they need.
The COVID-19 situation clearly illustrates the difficulties in mounting an adequate health response without clear and accurate data. Populations around the world are watching, outraged, as their governments are incapable of providing trustworthy and reliable information regarding the spread of disease and the number of people affected. Yet this situation is not all that dissimilar to what we have faced for decades with TB, and many other infectious diseases.
Without proper data to visualise the scale of the problem and adequately track our progress and measure our successes, we are going into battle blind.
We know that up to half of all people with TB may not be included in the data that we have, or they are diagnosed and started on treatment, but not documented by national programmes. Care cascade analyses frequently reveal gaps and delays, for example, between the presentation of symptoms suggestive of TB, and diagnosis, treatment start and completion.
Data allow us to visualise the progress of national TB control programmes (NTPs), or know when they have achieved the targeted improvements. Without this, we cannot strengthen our response. Weak documentation also affects the expansion of TB preventive therapy, which is crucially important in bringing an end to the TB epidemic.
To strengthen the quality of programmatic TB data and NTP recording and reporting, The Union has developed an innovative approach called TBData4Action.
TBData4Action is inexpensive, practical, and begins on the ground. Health staff, including facility and district level teams, are trained and supported through data-driven supervision, not only to collect and submit their own routine data, but to analyse and use it meaningfully. With presumptive TB registers and a new quarterly facility TB report, the district teams can concretely identify where in the care cascade the challenges are and in which facilities, and then direct their supervision accordingly.
Pilot programmes using this approach have already seen success in Zimbabwe, where the NTP has adopted the method for nation-wide expansion, and in Kenya where TBData4Action has been designated a best practice in the National Strategic Plan 2019 – 2023.
In addition, in Zimbabwe, this method has led to:
- an increase in TB detection, an improvement in treatment success, and reduction in TB deaths
- a decline in the proportion of people started on treatment without diagnostic sputum results
- an increase in HIV testing and antiretroviral therapy uptake
- more engaged and motivated health staff, and, ultimately, more active efforts made to ensure data quality.
As COVID-19 moves into many low- and middle-income countries, health services which are already stretched thin are facing massive additional pressure. Health care workers providing TB services are being called up to assist in screening and care for people presumed to have or diagnosed with COVID-19, creating shortages in TB facilities.
In situations like this, good record keeping and strong data can ensure the continuation of quality TB services – and lessons learned in TB recording and reporting may also help us to better manage the COVID-19 pandemic.
With tools like the TBData4Action approach and high-quality training and education, the world can be better prepared to respond to COVID-19, and ensure continuity of existing lung health programmes. The Union is inviting experts in their fields to share guidance and advice during these times of uncertainty in an open-access webinar series on COVID-19 and its intersection with TB, tobacco control and lung disease. Find out more and register here.