Editorial, Opinion Piece Discuss Efforts To End Tuberculosis, Improve Treatment Adherence

The Lancet: End the tuberculosis emergency: a promise is not enough
Editorial Board

“…The Lancet Commission on tuberculosis recommended actions for meeting global [tuberculosis (TB)] targets. Latent tuberculosis must be diagnosed and treated, Gene Xpert technology deployed worldwide to determine drug susceptibility, point-of-care diagnostics scaled up to minimize treatment delay, and safe drugs made affordable to retain patients with active tuberculosis in treatment. These interventions hinge on engagement by public and private sectors, strengthened management of tuberculosis programs, and increased investment in program support. These recommendations should focus future efforts, not least when stakeholders gather for the 50th Union World Conference on Lung Health in India on Oct. 30. … It is time for a civil society movement and a whole-of-society engagement to harness political commitment, transform promises into real advances, and consign this emergency to history” (10/26).

STAT: The resurgence of tuberculosis is behavioral, not medical. Nudges can fix it
Erez Yoeli, research scientist at the MIT Sloan School of Management and co-director of MIT’s Applied Cooperation Team; Jon Rathauser, founder and CEO of Keheala; and David Rand, associate professor of management science and brain and cognitive sciences at the Sloan School, director of MIT’s Human Cooperation Laboratory, and co-director of the Applied Cooperation Team

“…The cause of TB’s resurgence is not medical; a highly effective though burdensome treatment has existed for the disease since the mid-1940s. Instead, the cause is mostly behavioral: Faced with the prospect of extended treatment and isolating stigma, many people are slow to seek treatment or quit partway through. This fuels the tuberculosis epidemic by giving the disease ample opportunities to spread and mutate into drug-resistant strains … If the fuel is behavioral, then the solution should be as well. … Keheala — a homophone of the Hebrew word for community — is a platform designed to address the behavioral causes of not completing treatment by providing motivation and support throughout the arduous course of therapy. … To make the platform as motivating as possible, we incorporated principles from behavioral science, the same principles that have been successfully employed to promote charitable giving, volunteering, and resource conservation. … With millions of dollars being spent on medical solutions, our results suggest that we should pause and consider allocating more of that budget to behavioral solutions, so all that good medical research doesn’t go to waste” (10/25).