Mozambique’s Fight Against Tuberculosis: Progress, Challenges, and Future Strategies
Tuberculosis (TB) remains a significant public health threat, particularly for individuals living with HIV. In Mozambique, substantial progress has been made in expanding TB preventive therapy (TPT) among people newly initiating antiretroviral therapy (ART), reaching 89% coverage by March 2024. However, recent data reveals persistent challenges and highlights the need for targeted interventions to further reduce TB incidence.
The Impact of TPT: A National Success Story
Since 2007, Mozambique has prioritized TPT as a key strategy to combat TB among people living with HIV. The introduction of a 3-month course of isoniazid and rifapentine (3HP) in 2023, alongside the traditional 6-month isoniazid regimen, has further bolstered these efforts. A recent analysis of national data from 2021-2022 demonstrates a clear link between TPT completion and reduced TB incidence. Individuals who completed TPT experienced a significantly lower rate of TB diagnosis compared to those who did not start or incompletely finished the therapy.
Specifically, the incidence of diagnosed TB was 3.1 per 1,000 person-years among those who completed TPT, compared to 21.6 per 1,000 person-years for those who didn’t start TPT and 11.0 per 1,000 person-years for those with incomplete TPT. This underscores the critical role of ensuring patients adhere to and complete their TPT regimens.
Uneven Progress: Identifying Vulnerable Populations
Despite the overall success of TPT programs, certain populations remain disproportionately affected by TB. The data reveals higher TB incidence rates among men, younger individuals (<15 years), older individuals (>50 years), and those with poorer clinical status at the start of ART – including unsuppressed viral loads, low CD4 counts, and advanced WHO clinical staging (stages II-IV). Individuals in the Southern Region of Mozambique also exhibited elevated TB rates, potentially linked to regional variations in TB services and case detection.
Pro Tip: Targeted interventions focusing on these vulnerable groups are crucial for maximizing the impact of TPT programs. This includes tailored outreach, adherence support, and addressing underlying health factors.
The Future of TPT: Exploring New Approaches
While TPT has proven effective, ongoing research is exploring potential refinements to the strategy. The question of whether a second course of TPT would provide additional benefit for those who complete an initial regimen remains a subject of debate. A recent randomized controlled trial in Ethiopia, Mozambique, and South Africa did not demonstrate a significant advantage from a repeat course of 3HP. However, further investigation may be warranted for specific high-risk individuals.
Enhancing data quality and leveraging national data warehouses, like Mozambique’s MozART system, are also essential for monitoring program effectiveness and identifying areas for improvement. Continued investment in surveillance, testing, and outbreak preparedness, in collaboration with organizations like the CDC and USAID, will be vital for sustaining progress.
Strengthening Health Systems for Long-Term Impact
The success of Mozambique’s TB control efforts is inextricably linked to the strength of its overall health system. Support for the National Tuberculosis Control Program (PNCT) and the National Institute of Health (INS) network of TB reference laboratories, as well as training for public health professionals, are critical components of a sustainable response. Strengthening electronic health and laboratory information systems will further enhance data-driven decision-making and improve patient care.
Did you know? Mozambique closed its wild poliovirus outbreak in 2024, demonstrating the power of collaborative public health initiatives.
Frequently Asked Questions
Q: What is TPT?
A: TPT stands for TB preventive therapy. It’s a medication regimen given to people with HIV to prevent them from developing active TB disease.
Q: Why is TPT important for people with HIV?
A: People living with HIV are significantly more likely to develop TB. TPT reduces this risk and can save lives.
Q: What are the challenges to TPT implementation?
A: Challenges include ensuring patients start and complete the full course of therapy, reaching vulnerable populations, and maintaining data quality.
Q: What is MozART?
A: MozART is Mozambique’s national ART data warehouse, containing clinical data from over 1.6 million people living with HIV.
This ongoing commitment to collaboration, data-driven strategies, and targeted interventions will be essential for achieving epidemic control of TB and protecting the health of the Mozambican population.
