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The situation regarding COVID-19 has demonstrated to many the importance of global public health systems and the knowledge that diseases do not respect borders. These are facts that are very familiar to those working in the realm of TB. A global united response to COVID-19 is vital, as well as ensuring that this response takes into account the needs of people with TB, TB affected communities and TB survivors. We, as have many our members, have worked very closely with the World Health Organisation (WHO), WHO Regional Office for Europe and with many of WHO Country Offices across the region of Eastern Europe and Central Asia (EECA). Therefore, we wanted to take this time to reflect on our experiences working to end TB epidemic and aspects of this collaboration.
The risk to public health created by COVID-19 is extraordinary, and it is particularly dangerous for TB patients and those already vulnerable to TB. It is therefore vital that the WHO can continue its work in this realm, with its unparalleled potential to eliminate TB and other diseases.
The role of civil society
Over the last few years, the WHO has been increasingly aware of the important role that civil society and affected communities play in global health. This can be seen in the establishment of the WHO Civil Society Task Force on TB, of which our Director Yuliya Chorna became a member in 2018. The task force has a number of initiatives which vary from the development of framework for the evaluation of civil society collaboration, to advocacy on increased funding for TB, to catalysing collaboration between civil society organisations, National TB Programmes, and the WHO, among many other things. They have recently published a report on Engagement with Civil Society as the Driver for Change, highlighting the importance of civil society and recent projects to build collaboration between the WHO and civil society and TB affected communities.
The most recent example of this work can be seen in the development of the WHO multi-sectoral accountability checklist (MAF-TB checklist). This checklist has been created in response to requests from Member States, regions, civil society and partners as a tool to support the adaptation and implementation of the WHO Multisectoral Accountability Framework for TB (MAF-TB). It also responds to the UN General Assembly request to the WHO to ensure implementation of the Framework. We are sure that it will be a very useful tool for many of you in your collaborating activities with National TB programmes and in many other areas. Particularly relevant is Annex 2, which is dedicated to civil society engagement. This checklist provides the dimensions of meaningful engagement of civil society and TB affected communities in TB response as part of baseline assessments, with indicative discrete actions. The aforementioned Civil Society Task Force was particularly involved in its development and will be supporting countries and civil society partners using the checklist. We look forward to its increasing use over the next months and years.
The WHO ENGAGE-TB Approach also highlights the importance of integrated community-based TB activities and community health workers in tackling TB, working to integrate community based TB prevention, diagnosis, treatment and care into different existing health care and development initiatives and tracking key indicators through national surveillance systems. So far, 59 countries have adopted ENGAGE-TB and are reporting community contributions to TB outcomes to WHO each year.
Evidence-based infection control
With TBEC involvement at the regional level, we have been able to have very fruitful cooperation on strengthening the evidence-based infection prevention and control measures and fostering transition towards people-centred care for TB. This work includes the promotion of the guidelines on outpatient care and infectiousness in tuberculosis (2018) issued by the WHO Regional Office for Europe to the wider goals of combating stigma. We have seen great progress in increasing access to outpatient care, a key factor in building healthcare systems oriented to meet the patient’s individual needs.
Last year, the WHO (with involvement from the Civil Society Task Force) released its updated guidelines on drug-resistant TB treatment, transitioning from the common use of second-line injectable medicines for DR-TB to fully-oral therapy. As per earlier recommendations, therapy of multidrug-resistant TB (MDR-TB) took up to two years with a minimum of eight months of daily use of injections and more than 14,500 pills taken throughout the entire duration of treatment. These regimes often caused adverse effects, such as deafness, peripheral neuropathy, kidney failure, and other. The new system will be fundamental in changing the lives of people with TB. If you would like more information on these guidelines and how to encourage their use in your country, please watch our webinar on this topic.
The Regional Collaborating Committee on Accelerated Response to Tuberculosis, HIV and Viral Hepatitis (RCC-THV), initiated by the WHO Regional Office for Europe in 2012, is also a key platform that aims to build a united and intersectoral commitment to build a joint response to these diseases. The RCC’s ultimate objective is to contribute to the achievement of the Sustainable Development Goal 3.3 in Europe (by 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases). In order to do so, there must be a coordinated and integrated approach from health systems and other relevant sectors, people-centred models of care, and the involvement of civil society in the prevention and response to these diseases. The RCC-THV provides an opportunity not only discuss and share good practices and lessons learnt on the latest developments in TB, HIV and viral hepatitis, ranging from latest TB statistics in the region and access to new medicines, but also launch and discuss new initiatives, for example, research on the existing psycho-social support for people with TB in the countries of the WHO Europe region.
Throughout the last few years, the participation of civil society and TB affected communities in National TB Programme (NTP) reviews has been facilitated through the support of the WHO Regional Office for Europe. This engagement allowed for grassroots perspectives as to the success and barriers in TB programmes to be voiced, as well as providing recommendations for the format of quality people-centred care based on the personal experience of former patients. Currently the RCC-THV is continuing its work building the capacity of civil society and TB affected communities to serve on NTP reviews.
We are grateful for the successes that have been attained over the last few years and look forward to many more years of collaboration in order to end the epidemics.
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