March 24 is World TB Day
Themed “Wanted: Leaders for a TB-free World”, a 'TB leader', according to the Stop TB Partnership, is a head of state, minister, mayor, governor, parliamentarian or community leader.
At APOPO, in our 20-year history and one-and-half decades of TB research, we have encountered many of these formidable TB leaders who have contributed to the cause through ideas, vision, hands-on support, collaboration and financial assistance to embark on something new: to train rats to detect TB.
APOPO’s operational headquarters and first TB research site began in 2002 in Tanzania, supported by the Sokoine University of Agriculture. Research in Mozambique (since 2013) and Ethiopia (2018) has followed. These three countries have a common cause in that they face a high TB burden with approximately half of their nationwide TB patients remaining undetected. These ‘missed’ TB positive patients often include the most vulnerable, and those without proper access to care. Left untreated TB patients can pass on the pathogen to others, and up to two thirds of TB patients will eventually die.
APOPO is conducting on-going research into developing and deploying TB detection rats as a diagnostic tool. In brief, human sputum samples are collected from partner DOTS clinics that have already tested them for TB using locally available sputum smear microscopy, which has a limited sensitivity. Rats re-test these (heat-inactivated) samples and make additional positive indications that are then rechecked using WHO endorsed confirmation tests such as LED fluorescence microscopy. Confirmed TB-positive results are conveyed to clinics that orchestrate patient treatment. This research approach raises our partner clinic detection rates by 40%.
The action does not end here. We are engaging in partnerships with community health workers – often former TB patients who have decided to join patient organizations and take a lead – guiding newly diagnosed TB patients and linking them to care. The sample evaluation by rats also feeds into basic research on scent detection and on biomarkers, i.e. what the rats actually smell. The research on the rats may lead and guide the development and refinement of synthetic diagnostic devices, such as e-noses.
That this innovation roots in Tanzania is not by coincidence; the United Republic of Tanzania is a TB leader itself. It is in Tanzania where the first national, nationwide tuberculosis program was founded - the NTLP (Tanzanian National Tuberculosis and Leprosy Programme) - and it was here, where the shorter, supervised anti-TB treatment has been trialled in the hope of achieving higher cure rates. Tanzania’s research and experience would later feed into the new control strategy of the WHO.
We all can be TB leaders through our efforts to end TB in our own work or terrain. This can be as easy as spreading the word that TB still exists, kills, and is a major issue in economically challenged countries. As Lucica Ditiu, the Executive Director of Stop TB Partnership states: “We owe [it] to us and future generations […]. We must end TB!”
APOPO thanks health authorities across the countries in which it works for their continued support, in addition to funding partners.
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