Every year, 24^th March is set aside to commemorate World Tuberculosis Day (WTD).

The theme for this year’s WTD - The Clock is Ticking - is timely to remind the world about the slow progress made in acting on commitments made to end tuberculosis (TB). Regrettably, the COVID-19 pandemic has put the global promise to #EndTB by 2030at risk and as well as efforts to ensure equitable access to TB testing, treatment and prevention.

Ghana's situation

In 2019, an estimated 44,000 people developed TB in Ghana, of whom 9,200 occurred among people living with HIV. In the same year, an estimated 10,000 HIV negative people died of TB and an additional 5,000 people living with HIV also died of TB.  

Despite these numbers, only 14,691 people with TB were diagnosed, started on treatment, and notified to the National TB Programme. This suggests that only 34% of the people with TB in Ghana were able to access treatment, a worrying figure.  

Fortunately, in Ghana, once a person with TB has been diagnosed and treated, they are also to receive the HIV services they need. In 2019, 85% of people on TB treatment knew their HIV status; of whom 21 % (2,620) were known to be living with HIV and 75% were receiving HIV treatment.

TB is a leading cause of illness and death among people living with HIV, only 4% of people recently started on HIV treatment were receiving TB preventive treatment—a course of medicine that greatly reduces the risk of falling ill or dying from TB—and an additional 7% were on treatment for TB disease.

These two percentages should add up to 100%. All people who start on HIV treatment should be screened for TB, if negative they should start TB preventive treatment. If they have TB symptoms they should be investigated for TB disease and treated if necessary. 

In Ghana, only 11% of people starting HIV treatment were receiving “optimal TB care” in 2019.

With the emergence of COVID-19 in 2020, there has been significant loss of progress towards achieving the END TB targets by 2022 set by the United Nations. The Ghana National TB Programme estimates about 25% less TB cases diagnosed, enrolled in treatment, and notified due to COVID 19. This sets back TB control efforts in Ghana by about 10 years.

But TB and COVID-19 are spread in similar ways, mostly through airborne droplets created when an infected person coughs, sneezes or sings. So respiratory infection control measures, mask wearing, covering cough and good ventilation will reduce the transmission of both diseases.  

Progress towards the Political Declaration Targets

The 2016 Political Declaration on Ending AIDS set a global target to reduce TB deaths among people living with HIV by 75% between 2010 and 2020 .

Similarly, at the 2018 UN High Level Meeting on Tuberculosis, global leaders made a commitment to end the TB epidemic globally by 2030 and to reach ambitious interim targets 2022 to accelerate towards ending TB by 2030.  While facing the COVID-19 pandemic, we still must strive to reach the TB targets but time is running out, we only have until December 2022 to make good on the political commitments.   

There is no time left to sit around without acting. “The Clock is Ticking.”  We call on all political, traditional and religious leaders to join and support us to act now!!

Key activities that Ghana must fully implement to end TB, especially among people living with HIV include:

•  Deliver integrated person-centred care in a one-stop-shop and not disease-specific clinics.
• Test and treat all people with TB or possible TB for HIV and vice versa.
• Trace all family and household contacts (especially young children) of people on TB treatment, people on HIV treatment and people with COVID and test them for TB, HIV and COVID.
• Actively undertake community screening for HIV, TB and COVID among high-risk populations (urban slums, malnourished children, mining communities, diabetes patients). 
• Empower health care workers to screen all clinic attendants for COVID-19, TB, and HIV
• Provide TB preventive treatment (TPT) to all people living with HIV who do not have signs of TB disease, children and adult contacts of TB patients.   
• Improve TB screening with digital chest X-ray and new innovative diagnostic tools such as GeneXpert, LF-LAM, and TB LAMP. 
• Improve monitoring and treatment support to people with TB and HIV using digital tools and mobile applications.   

Tuberculosis remains the leading cause of death among people living with HIV, despite being curable and preventable. Early detection and treatment are life saving for both TB and HIV. TB preventive therapy is vital to preventing latent TB infection from advancing to TB disease and reduces the risk of dying from TB among people living with HIV by almost 40%. In this era of COVID-19 it is important to test all people reporting with respiratory symptoms for both TB, COVID-19 and for HIV. In Ghana HIV prevalence is high among people with TB and people being tested for possible TB.

According to Ms Angela Trenton-Mbonde, UNAIDS Country Director “All people living with HIV who are on HIV treatment should be screened for TB and if positive, they should be tested and treated for TB, if they are negative, they must be encouraged to take TB preventive treatment. Time is not on our side as the clock is ticking and waits for no one. We urgently need joint action to end TB and end AIDS by 2030.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

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The Author, Ms. Angela Trenton-Mbonde, UNAIDS Country Director