Under the World Health Organization (WHO)’s End Tuberculosis (TB) Strategy, countries around the world have set out 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 work as a UN Volunteer supporting the National TB Programme, under the UNDP/Global Fund Multi-Country Western Pacific Integrated HIV/TB Programme. In 2019, there were 419 cases of TB 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, the National TB Programme activities, which play a key role in early prevention, detection, diagnosis and treatment – have been hampered by restrictions on movement and interruptions to TB drugs and supplies. In 2020, the number of cases being detected dropped to 388, and there is worry that treatment success rates may decline as well.
I’ve seen first-hand how these disruptions are threatening to reverse some of the hard-fought progress. There are two areas in particular that 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 the 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 amount 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, and so the supply of everything depends 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, 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 getting 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: Cook Islands, Federated States of Micronesia, Kiribati, Nauru, Niue, Palau, Republic of the Marshall Islands, Samoa, Tonga, Tuvalu and Vanuatu.