Considerable progress has been made on tuberculosis (TB) in the Western Pacific region over the past few decades, but more work is needed to meet targets set out in global strategies aimed at bringing an end to the epidemic. A recent workshop in Nauru was held as part of the continuing efforts to achieve these targets through strengthening the capacity of health workers on prevention, care and control of TB.

The two-day workshop was a refresher course for health workers, including medical doctors, nurses, clinicians and DOT (directly observed treatment) workers, on the National Guidelines for Programmatic Management of TB. It was organized on 11-12 August 2020 by the World Health Organization (WHO) under the United Nations Development Programme (UNDP)’s Multi-Country Western Pacific Integrated HIV/TB Programme.

The Nauru National Guidelines were developed by the Ministry of Health in partnership with the WHO and UNDP are an important tool for the national TB response. The Guidelines are customized to the local context and are based upon WHO’s 2019 global guidelines, which provide up-to-date, evidence-informed recommendations on TB infection prevention and control, in alignment with targets of the WHO End TB Strategy and the Sustainable Development Goals.

In addition to Nauru, National Guidelines have been produced under the Multi-Country Western Pacific Integrated HIV/TB Programme for Cook Islands, Federated States of Micronesia, Kiribati, Niue, Palau, Republic of Marshall Islands, Samoa, Tonga, Tuvalu and Vanuatu.

“The training session on the Nauru National TB guidelines comes at a very crucial time as the number of TB cases being identified in Nauru continues to rise and newly recruited TB DOTS [directly observed treatment, short-course] workers, health care workers and clinicians join the Nauru Health team,” said Stacey Cain, Acting Director of Public Health at the Nauru Ministry of Health and Medical Services. “It is essential that the guidelines are universally applied in the identification process and the management of TB cases to ensure that Nauru attain its targets towards ending TB.”

Globally, TB continues to be the world’s deadliest infectious disease – claiming the lives of 1.5 million people in 2018, including more than 250,000 people with HIV. In the Western Pacific region, reductions in TB incidence (new cases) has slowed in recent years.

According to the latest data from WHO, the TB incidence in Nauru in 2018 was 54 per 100,000 population – making it a moderate burden country – and the treatment coverage rate was 87 percent. However, the total number of TB cases remains low, owing to the small population of the country.

Nauru is one of the smallest island-states with a population of about 11,000 people, on just 21 square km of land. The country has a triple public health burden of communicable diseases (including TB), non-communicable diseases and health impacts associated with climate change. Rising sea levels, combined with increases in population, are forcing people to relocate from the traditional coastline habitation to inner island regions, causing overcrowding. The current COVID-19 pandemic is also straining the health system, exacerbating the challenges.

“Nauru has seen an increase in reported cases of TB over the past two years,” said Gayane Tovmasyan, Regional Programme Manager at the UNDP Pacific Office in Fiji. “Collaborating with our programme partners to strengthen the skillsets, technical knowledge and overall capacity of health workers, to provide the best services and treatment to the people of Nauru, without leaving anyone behind, is vitally important at this time.”

“Health workers play a central role in TB elimination – they are our frontline soldiers against this infectious disease,” said Dr Subhash Yadav, a technical expert at the WHO Pacific Office who led the training. “Increasing our efforts to strengthen their capacity is essential if we are to achieve the targets of the End TB Strategy, including 90 percent reduction in TB deaths and an 80 percent reduction in TB incidence by 2030.”

The training covered a range of topics, including TB transmission, classification and infection prevention and control; diagnosis and treatment; adverse drug reactions; treatment in special conditions; management of TB in children; TB and co-morbidities; management and screening of contacts; as well as Mantoux testing for latent TB.

Strategies to reduce stigma and discrimination of people affected by TB and to promote a human rights-based approach to TB are embedded throughout the training curriculum and guidelines. 

Another focus of the training was on the use of GeneXpert machines, which were introduced in Nauru by the programme in 2019. GeneXpert is an important tool for diagnosing TB by detecting the presence of the bacteria that causes the disease, as well as testing for resistance to the drug Rifampicin.

The Nauru workshop was the first in what will be a series of national level trainings on the Guidelines to be organized by WHO and UNDP under the Multi-Country Western Pacific Integrated HIV/TB Programme over the next several months. Due to COVID-19 related travel restrictions, the workshops will be held in a virtual format, rather than in-person – a ‘new normal’ which the country partners are rapidly adapting to.  

UNDP and the programme partners are working to overcome challenges presented by the global COVID-19 pandemic to advocate for and support the most vulnerable, working to reduce stigma and discrimination and ensure access to prevention, care and treatment services.