Budi*, 52, was diagnosed with tuberculosis (TB) at a public primary care clinic in Jakarta, Indonesia, four years ago. He began treatment but did not complete it, so his symptoms returned.
After consulting a private doctor and a private hospital, Budi restarted treatment — but his condition worsened over the next two years. Because those health providers did not have specialized molecular diagnostic tests, no one knew that Budi’s form of TB was resistant to the drugs being used to treat him.
For many people like Budi, who seek care in private health care settings, the lack of drug-resistant TB services is a major barrier to receiving an accurate diagnosis and lifesaving treatment.
But now, there is new momentum in the global fight against drug-resistant TB. In Budi’s case, he was referred to Indonesia’s first private hospital to offer services for drug-resistant TB. Over the next two years, he completed treatment and was cured.
To help more patients like Budi, the global health community needs to act now to build on the momentum from the latest tools. We should do this by leveraging the extensive reach of private health sectors, where many patients worldwide obtain treatment.
A ‘public health crisis’
On October 29, the World Health Organization (WHO) released its Global Tuberculosis Report 2024, which described TB as, once again, the world’s “top infectious disease killer.”
The WHO specifically called out drug-resistant TB as a “public health crisis.” This is because, in 2023, only 30% of the estimated 400,000 people with drug-resistant TB successfully completed treatment. While treatment success rates are inching higher, fewer than half of those with drug-resistant TB were diagnosed and treated in the first place.
Even for those correctly diagnosed, specialized drug-resistant TB treatment is usually centralized and limited to public health services in major cities. In many countries with a high burden of drug-resistant TB — such as India, Pakistan, Indonesia, and the Philippines— people prefer to seek health care from private providers.
There has been progress in the drug-resistant TB treatment journey. WHO-recommended molecular tests can detect it quickly and accurately. New drugs and shorter, better drug regimens are becoming more widely available. WHO now strongly recommends specific drug-resistant TB preventive treatment for patients’ contacts. But these diagnostics and treatments are rarely available outside of government health systems.
What is needed now to reach TB epidemic control
If we are to reach TB epidemic control, urgent action is needed to fix the specific public health crisis of drug-resistant TB.
National and subnational governments, TB partners, stakeholders, donors, advocates and communities must work together to ensure that health systems do the following:
- For people seeking care in the private sector, ensure they can access recommended tests to detect drug-resistant TB.
Too many people with drug-resistant TB remain undiagnosed or misdiagnosed. To ensure equitable access to diagnosis, the private health sector must offer molecular diagnostics or specimen transport systems to appropriate molecular technology.
To make these newer tools accessible wherever people seek care, several procurement approaches are available that private health facilities can explore. These include the private purchase or lease of machines, or publicly procured machines and/or reagents placed within private sector facilities.
- Expand access to treatment and prevention services into private sectors, including building capacity and systems.
To facilitate treatment adherence and reduce treatment interruption, drug-resistant TB treatment and care services must be located near where people live. In many places, private health facilities are located closer to people’s homes, have more patient-friendly hours, and/or are the trusted providers. Also critical is the inclusion in private facilities of community support services that exist in the public sector, such as bringing medicines to people’s homes, providing transportation and supporting adherence to treatment regimens.
The private sector should also be included in the rapid scale-up of new regimens for treatment and prevention, including rollout and training efforts for the new WHO drug-resistant TB treatment guidelines when they are released in early 2025.
- Promote local ownership and leadership.
Local ownership and leadership are necessary to achieve equity, effectiveness and sustainability in drug-resistant TB care, where, historically, private sector entities have had little engagement. Both formal and informal private providers, including pharmacies, should be engaged to help find people with undetected drug-resistant TB and ensure that they receive quality treatment.
To reap the benefits of newly available tools, everyone involved in the fight against drug-resistant TB — government, partners, community organizations, survivor networks and advocacy groups — has a role in transforming global guidance, such as that from WHO, into national-level and local action.
If the latest diagnostics and treatments are made available at private health care facilities, more people will have access to timely, accurate diagnoses and be supported to complete treatment for drug-resistant TB. This should happen in countries and communities where the drug-resistant TB burden is high and there is an existing large private health sector.
Now is the chance to accelerate progress toward ending a deadly epidemic and improving the lives of those affected in lasting ways.
*Name has been changed
