Although Tuberculosis (TB) is preventable and curable, in 2022 alone 1.3 million people died of the disease. The TB REACH initiative of the Stop TB Partnership is the only global mechanism that tests innovative approaches to TB case-finding and prevention services for the most vulnerable to this disease. KIT has been an independent monitoring and evaluation partner for the initiative since its inception in 2010.

Over the years, we’ve monitored ten waves of implementation programmes and over 80 projects. Projects typically last around 18 months and are implemented globally. There are 26 projects in Wave 10, and KIT monitors 10 of these projects in Asia and Africa. Our team consists of four advisors, Christina Mergenthaler, Chantal Al Lakis, Mirjam Bakker, and Nwanneka Okere, and three consultants based in Rwanda, Bangladesh, and Pakistan.

Earlier this month the team, led by Mirjam Bakker, visited the projects as part of their annual trip to monitor the projects in each wave. The team also met all the grantees of Wave 10 in the first-ever mid-term grantee meeting. Since this year marks the 10th wave of this project, we talked to Mirjam about the developments she’s witnessed over the ten waves.

The First Wave

“Things were very different back in the day when the project first started. At the time, there was more of a sense of urgency to conduct more active-case finding – to move away from the approach to wait for someone who might come in with a cough,” explains Mirjam. Mobile teams, for example, would then go into the community and test specific groups of people with poor access to TB care or ask if anyone had a cough.

“In the first wave, we saw an enormous rise in the number of people diagnosed with TB where the projects were implemented,” she adds. Then, in the second and third waves, the projects adopted new technologies like GeneXpert and digital X-ray. Then, it was ground-breaking, but now it’s become much more commonplace to use these technologies.

According to Mirjam, another positive development we’ve seen over the years is the shift toward integrating these project’s activities into the country’s overall health system. “The projects need to carefully consider how they can integrate TB screening into other parts of the health system and strengthen it.”

When asked why that is so important, Mirjam responds: “TB should not be viewed in a silo. We’ve seen with COVID-19 that TB control came to a standstill during the pandemic. Furthermore, in many of the countries that carry the burden of TB, other diseases like cardiovascular diseases, malaria, and diabetes are also as prevalent. So we need to develop integrated testing for the community health workers.”

Ending TB by 2030

Another change Mirjam and the team have witnessed, especially in Wave 10, is the emphasis on prevention through preventive therapy. For example, previously, when a person was diagnosed with TB, their contacts would be screened, and the outreach would end there. But now, in Indonesia, for example, the contacts are also screened for infection, and if someone has the infection but hasn’t contracted the disease yet they still get preventive therapy. If you have the infection, there is a substantial risk that you will contract the disease, and preventive therapy is much lighter compared to taking therapy while also having TB disease.

Mirjam also points out that the donors have had quite an impact on the development and direction of these projects too. “The push to integrate health systems strengthening into the projects has been the initiative of a new funder and it’s an approach we wholeheartedly support,” she explains.

But this isn’t the last wave. TB REACH is now in the process of finalising and approving projects for the next wave. It’s scheduled to start in the latter half of 2024. The goal, set by the UN last year, is to end TB by 2030. TB is a leading infectious disease – second only to COVID-19 – so the goal is ambitious. But given the developments we’ve witnessed over the last decade or so, it’s not impossible.