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Tuberculosis is often thought to be a relic of the past. Many people are surprised to learn Mycobacterium tuberculosis is one of the top ten causes of death worldwide. It is also the biggest infectious killer. In 2016 alone, over 1.7 million people lost their lives to this very curable disease, which equates to 4,500 people a day.

Most infections are in low- and middle-income countries, where many people live in more crowded conditions. They also tend to have more health issues, but less access to healthcare than high-income countries. With tuberculosis, the necessary six months of daily treatments can present additional economic and social challenges that are difficult to overcome. These include obstacles such as the time and costs of travelling to far-away clinics. What’s more, tuberculosis patients face lack of social support, or associated stigma. Unfortunately, inadequate and/or partial treatment regimens have now led to drug-resistant strains of the bacteria, which can be transmitted to others. This makes it even more imperative to eradicate tuberculosis and end this public health crisis sooner rather than later.

Through the Sustainable Development Goals (SDGs), the global community has called for a totally tuberculosis-free world by 2030. But ending the epidemic is about more than just medical treatment. It also needs to be about preventing infections in the first place.

South Africa faces some of the highest rates of the disease known to the world. Primary healthcare facilities are responsible for providing tuberculosis treatment. As such they have guidelines to prevent new infections such as face masks, ventilated waiting areas, etc. However, there are high rates of the disease among healthcare workers themselves, which suggests that these guidelines are followed inconsistently. But why?

Umoya omuhle: a response to drug-resistant tuberculosis

Umoya omuhle was born in response to that question. The mother can be roughly translated as a ‘breath of fresh air’ in Zulu. It was coined for a three-year collaborative project with researchers from seven institutes across the UK and South Africa, based out of the London School of Hygiene & Tropical Medicine. Using a whole-systems approach, they focus on different dimensions of infection in these clinics, including the way air (and thus M. tuberculosis) flows through the buildings, how people move around the space, and the views of healthcare workers on infection prevention.

The researchers are studying everything from the ventilation systems to where people sit or stand in the waiting rooms. They are also exploring how clinic workers think and act about the risks. Ultimately, they are aiming to develop a health systems intervention that can help stop new infections of drug-resistant tuberculosis. As part of the whole systems approach, the team also has to consider the social, biological, and political reasons for the continued existence of tuberculosis in South Africa. This is something other countries will need to do as well.

A growing global priority

Indeed, many organisations are giving increasing attention to the problem from all corners of the world. In the UN Headquarters in New York, preparations are underway for the first high-level TB meeting during the General Assembly in September. With the UN calling it a “tremendous and unprecedented step forward by governments and all partners engaged in the fight against TB,” the meeting is expected to result in a firm and ‘ambitious’ political declaration by all heads of state. It will also commit to the end of the killer lung disease even more firmly than the SDG targets.

While the political powers that be come to such an agreement, the question of ‘how’ still whirrs in the background. Meanwhile the researchers of Umoya omuhle are dedicated to figuring out how the pieces of the puzzle fit together in South Africa.

Naomi Stewart is a communications officer at the London School of Hygiene and Tropical Medicine. She works directly with academics, groups, and projects – including Umoya omuhle – to communicate their research clearly and effectively. You can find her at @naomimstewart.

Photo copyright: Ben Garber/Wellcome.