Janice C. Caoili, MD
The WHO Global Tuberculosis Report 2022 highlights the growing health challenge posed by tuberculosis (TB) in the Philippines: In 2021, TB incidence and deaths due to TB increased, accompanied by continued reduction in TB case notification. The Philippines contributed around 10% of the estimated global reduction in TB notification from 2019 to 2021. Of the estimated 741,000 cases of new and relapse TB cases, only 43% were diagnosed and officially reported. Most TB cases remained undiagnosed and untreated, potentially infecting more people in the community.
The Philippines is one of the 30 countries in the three global lists of high-burden countries for TB, HIV-associated TB and multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB). Among the reported TB cases in 2021, only 65% were tested with rapid diagnostic tests. Xpert MTB/RIF is the most widely available rapid molecular test for TB. It can determine TB and rifampicin resistance, which is a marker for MDRTB. Use of this test is crucial for timely detection of drug-resistant TB (DRTB) cases and initiation of appropriate TB treatment.
In 2021, only 34% of TB cases were tested for HIV, which was much lower than the 76% global coverage of HIV testing among people diagnosed with TB. All TB patients should be offered HIV testing, as provision of antiretroviral treatment is lifesaving and significantly improves TB treatment outcomes. HIV is also a known risk factor for development of MDRTB.
In 2020, the reported treatment success rate for drug-susceptible TB (DSTB) cases in the Philippines was 76% – lower than the global average of 86%. This likely reflects constraints on access to continuous health services during the pandemic and incomplete reporting of treatment outcomes from health care facilities.
Around 1.5% of new TB cases in 2021 had MDRTB. Drug resistance can develop among patients who are non-adherent to their anti-TB drug regimens or are inappropriately treated with anti-TB drugs. Individuals infected with MDRTB can infect others with MDRTB strains. MDRTB can cause severe disability and even death. Infected individuals who commit to treatment for MDRTB must take many medications for many months to years.
MDRTB can be prevented via public health programs ensuring that all TB patients have access to quality-assured rapid diagnostic tests, effective anti-TB drugs, and a supportive environment of healthcare workers that promotes treatment adherence and control of risk factors such as malnutrition, smoking, alcohol abuse, diabetes and HIV. Poverty alleviation, more funding for TB programs, and strong political will are key to the success of these programs.
The Philippine Coalition of Tuberculosis enjoins all sectors of society to work together to stop all forms of TB.
We support the DOH in the implementation of rational use of antimicrobials to curb the threat of multidrug-resistant organisms through the One Health approach.
Reference: World Health Organization (WHO) Global Tuberculosis Report 2022 (https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022)