On World Tuberculosis Day, 24 March, we raise awareness about the devastating health, social and economic consequences of Tuberculosis (TB) and efforts to end this epidemic. The theme this year – The Clock is Ticking – conveys the urgency to step up efforts and act on commitments to end TB, particularly in the context of the COVID-19 pandemic. Dr Innocent Nyandwi (Rwanda) is a UN Volunteer TB/HIV Medical Officer serving with the UN Development Programme (UNDP) in Kiribati. He shares his experience of the disruption caused by COVID-19 that threatens to reverse hard-fought progress on TB.
Under the World Health Organization (WHO)’s End Tuberculosis Strategy, countries around the world have set ambitious targets to reduce the number of TB cases and deaths, as well as catastrophic expenses due to TB, by the year 2035, with interim milestones set for 2020 and 2025. Even before the onset of COVID-19, we were running out of time, and now, because of the pandemic, the targets are in jeopardy.
This is especially the case in Kiribati, where I am a UN Volunteer supporting the National TB Programme, under the UNDP/Global Fund Multi-Country Western Pacific Integrated HIV/TB Programme. In 2019, 419 cases of TB were detected in Kiribati, among a total population of about 120,000 people. This is the highest burden of TB among Pacific island countries. TB continues to be a public health issue here, with persistent transmission in the population, sub-optimal prophylaxis among children, inadequate contact tracing and a regular trickle of drug resistant cases.
Since the start of the COVID-19 pandemic in late 2019, activities of the National TB Programme – which play a key role in early prevention, detection, diagnosis and treatment – have been hampered by restrictions on movement and interruptions to delivery of TB drugs and supplies. This caused a decline in active case finding and a drop in cases detected to 388 in 2020, although WHO projected an increase, and is coupled with concern that treatment success rates may decline as well.
My role in Kiribati is to support with early TB prevention, detection, diagnosis and treatment, and build the capacity of medical staff in these areas. I support the Ministry of Health in TB planning and reporting, HIV clinical support and overall supervision of implementation of and reporting on UNDP activities.
As UN Volunteer, it makes me feel happy to support people in need and I am gaining more experience which will help me in the future. My main challenge is that I cannot go home to see my family due to COVID-19, but I am gratified to contribute to the SDGs, especially SDG 3.
I have seen first-hand how these disruptions are threatening to reverse some of the hard-fought progress. Two areas in particular are being impacted:
Active case finding. Pro-active and systemic searching for cases and providing effective treatment is key to ending TB. This is mainly done through sessions with TB mobile clinics and TB mass screenings in hotspot communities, regular contact tracing in the community and triage sessions at health care facilities, as well as twice weekly medical consultations at the TB clinic. Due to the COVID-19 pandemic, a number of mobile clinic activities have been cancelled, due to restricted movements, especially on outer islands, negatively affecting the number of cases being detected and effectively treated. As a result, people have been limited to only being able to access regular static clinics. Lockdowns and restrictions on movement have also interrupted TB drugs and supplies reaching health workers and patients, which has forced some active case finding activities to be postponed or cancelled altogether.
TB case management. Kiribati is in an extremely remote location, so supplies depend on air transport. Lockdowns and border closings have severely limited flights coming in and out of the country. The regular supply of TB drugs has been repeatedly cut off, causing frequent stock outs of drugs and laboratory supplies. This situation has caused intermittent stoppages to people’s treatment, contributed to poor adherence of the treatment, increased risk of decreased TB treatment success rate and has increased the risk of TB deaths and multidrug-resistant TB.
The Government of Kiribati, with support from UNDP, the World Health Organization (WHO) and other partners, is organizing essential international charter flights to bring the needed supplies into the country, and local flights to facilitate movements to outer islands. Despite the challenges, the National TB Programme is managing to continue many of its other important TB prevention activities in the community.
With the continued support of UNDP, WHO and the Global Fund, and with the world eventually gaining control of the COVID-19 pandemic, we are cautiously optimistic that Kiribati, and other small island countries in the Pacific, will be able to achieve their goals to put an end to TB by 2035.
 The Multi-Country Western Pacific Integrated HIV/TB Programme is financed by the Global Fund and implemented by UNDP and aims to strengthen control of HIV and TB in 11 Pacific island countries: the Cook Islands, Federated States of Micronesia, Kiribati, Nauru, Niue, Palau, Republic of the Marshall Islands, Samoa, Tonga, Tuvalu and Vanuatu.