Over the four days of scientific discussions certain themes emerged that set the tone and the direction of the expert presentations during the Union World Conference on Lung Health:
- TB transmission rates are not declining and cases of multiple drug-resistant strains are growing, both undiagnosed and untreated. More funding sources, and more public-private sector partnerships are needed to effectively address the disease, supplementing the financial pressures on highly diseased burdened countries.
- It is no longer tolerable to seek “control of TB” when 1.4 million people die from a very treatable disease. It is time to “eliminate TB”. It is time to seek “Zero” deaths. Much like the advocacy surrounding the early days of HIV, efforts that raised awareness and caused more funds to flow into research and drug therapy, this same level of community activism is needed to attract the necessary funding to eliminate TB. HIV and TB advocacy and funding should not be considered as separate initiatives. Given the co-infection of TB in HIV patients, it is time to think of these diseases together, and seek funding to fight both of them simultaneously.
- Passively waiting for sick patients to walk into health clinics to be tested, diagnosed and treated for TB will never eradicate the disease. More active initiatives are needed to reach out into the most affected areas, through community outreach and mobile clinics, supported by innovative diagnostic tools, new drug therapies, and better vaccines.
- In spite of the advances in diagnostic technology (PCR, NAAT, and others) the adoption of the technology has been slow. In part this is due to limited healthcare budgets, making widespread deployment unsupportable. Price remains a barrier to the scaled-up use of the technologies that are needed to actively seek out new TB suspects.
- As noted frequently during the conference, both by presenters and attendees alike, “sputum microscopy remains an important diagnostic tool, oftentimes the primary tool, and it is here to stay in the labs for some time yet.”
TBDx and automated sputum microscopy is in a unique position given the practical financial realities facing infectious disease budgets. As departments move towards more active, community-oriented initiatives, TBDx and its 200-slide configuration can make important contributions to the increased diagnosis of the disease expected as case findings increase. Its ability to process slides unattended throughout the evening not only will increase diagnosis and patient notification, but also detect scanty TB cases often missed by routine microscopists, directly affecting disease transmission. It can present digital evidence of TB detected by the software and offer microscopists an opportunity to examine these images, if desired. It can complete a test in under five minutes, and communicate test results to portals, to mobile phones, or to laboratory information systems. Given the financial pressures on labor expenses, or access to available human resources needing to be trained and supportive of an expanded detection initiative, the introduction of automated sputum microscopy is most timely.
These capabilities, demonstrated to hundreds of TB experts and policy-makers attending the conference, contributed to attracting a large audience to hear Dr. Nazir Ismail present the findings of the South Africa evaluation. Next week we will go into performance details surrounding the evaluation and provide a link to the slides used in the presentation.