Union World Conference on Lung Health: How to treat TB during war and conflict

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Science Speaks is in Cape Town, South Africa this week, providing live coverage of news and events at the 46th Union World Conference on Lung Health.

Science Speaks is in Cape Town, South Africa this week, providing live coverage of news and events at the 46th Union World Conference on Lung Health.

CAPE TOWN, South Africa – Imagine you’re one of the 1.5 billion people who live in one of the 42 countries currently affected by war and conflict. One day you must flee with your family and leave everything you’ve known behind in a desperate attempt to save your life. Now you’re one of the 60 million globally who have been displaced from their homes.

Now imagine you have a life-threatening disease that requires two years of treatment, including painful injections and 20 pills each day that make you feel extremely sick, and may make you lose your hearing, along with a host of other debilitating side effects. Life as a refugee not only means treatment interruption, but the fear of transmitting your disease to those around you, especially in crowded refugee camps.

This was the reality for 19-year-old Aman, who fled Eritrea as a refugee and traveled by foot and boat to Europe, two months after being diagnosed with multidrug-resistant tuberculosis. Aman is one of many tuberculosis patients the KCNV Tuberculosis Foundation has supported in conflict areas, Kathy Fiekert of the Foundation said at the Union World Conference on Lung Health.

Along with Médecins Sans Frontières, KCNV Tuberculosis Foundation is one of several humanitarian organizations that provide tuberculosis services to people in countries affected by conflict, many of which have high burdens of TB, said Anita Mesic, senior advisor for MSF.

“Conflict is associated with a 20-fold increase in tuberculosis,” she said, “and a tuberculosis crisis is prolonged for years after conflict ends.”

“TB control in stable settings is challenging enough,” Mesic said. “In unstable settings, it’s so much worse. There’s extremely reduced access to healthcare services or insecurity to come to healthcare services, no healthcare workers, and no drug supply,” she said.

MSF has provided tuberculosis services in a number of conflict areas, including in Ukrainian prisons in the Donetsk region during conflict that erupted in summer 2014. They were forced to leave and had to leave what little drugs they had behind.

The conflict resulted in “a rupture of stocks of second-line drugs, no staff, no access to patient support teams, no possibility to conduct follow up,” Dmitri Donchuk, with MSF, said.

From their experience in the Ukraine, Donchuk said, MSF responders learned that they need contingency plans for dealing with service interruption during conflicts, which include localizing supplies, and implementing regimens with short treatment duration.

MSF met with some success with delivering short courses of treatment in Somalia, when the nine-month Bangladesh regimen for treating MDR-TB was used in 2013, Esther Casas said. The package of services included strict directly observed therapy, home-based care, enhanced counseling, and a treatment supporter, she said. Treatment success for 65 patients who were placed on the short course of treatment was 68 percent, she said, but the program ended when MSF was asked to leave Somalia.

Tuberculosis can be treated in the middle of conflicts, Mesic said. Service providers must have a tailored response around the conflict, she said, and adjust models of care to include giving people enough medicines if they have to move, on top of having enough emergency funding to respond as effectively as possible.

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