The BBC reported this week on the ongoing investigation into the death of 15-year-old Alina Sarag, a teenager from Birmingham, UK. She died in January of tuberculosis (TB), a disease caused by a bacterial infection that passes from person to person through the air. She was one of millions who have died from TB because they were never diagnosed.
What makes young Alina's death an outrage is that both she and her parents suspected she had the disease early on. If diagnosed properly, TB is curable in the vast majority of cases. Alina had been treated for TB in 2009, and she was suffering similar symptoms in late 2010. London has the highest TB rates of any capitol city in Europe, and rates in Birmingham (two hours northwest of London) have skyrocketed in recent years.
However, none of the five physicians who examined her provided her with a TB test. They told her she had bulimia. They said she was "heartsick" over a boy. They advised her to see a psychiatrist. All of this, despite her father's insistence that she be tested for TB.
"I remember specifically asking for another TB test for Alina to make sure it was not the cause of the illness," he told investigators. The Telegraph reports that he called Alina's physician over 50 times but never heard back.
Alina finally did receive that test, after being admitted to Birmingham Children's Hospital on January 6. She died the same day. By that time, the girl was so ill that she had to be carried. "I would spend hours rubbing her back, arms, head and neck to try and help ease her pain," her father told the Huffington Post UK.
It could have taken less than two hours to save her life, had Alina had access to the newest TB diagnostic test. Called Xpert MTB/RIF, the test returns a diagnosis in about 90 minutes. It was endorsed by the World Health Organization in December 2010.
Let this fact, be something that the tragedy of Alina's experience and her family's loss teaches us. Let it help us wrap our minds around how much suffering TB causes in the world, and what we can do to end it.
More people die from TB today than ever before -- 1.4 million people each year, according to the World Health Organization. Part of the reason is that TB is still diagnosed in most parts of the world using a method invented in the late 19th century. A patient coughs up phlegm, the phlegm is smeared on a microscope slide, and a human looks into the microscope and tries to find the bacterial germs with his or her own eyes. Needless to say, the test is wholly inadequate and fails to find about half of TB cases.
Since WHO endorsed it, Xpert MTB/RIF has been introduced in over 50 countries. But its roll-out has been slower than it should be, primarily because of concerns about how much the test costs. Compared to the microscope test, Xpert MTB/RIF appears to cost a lot more -- each Xpert test cartridge costs roughly $17, versus less than a dollar per microscope slide.
A new study published this month will turn that absolutely false economy on its head. Researchers from the US Centers for Disease Control and Prevention, publishing in the Journal of Acquired Immune Deficiency Syndrome (JAIDS), compared the cost-effectiveness of diagnosing TB by relying on microscopes with diagnosing TB using Xpert MTB-RIF. (They also compared the cost-effectiveness of growing TB in culture, a highly reliable yet painstakingly slow process that requires a sophisticated laboratory rarely found in developing countries.) They focused their research on people with TB-HIV co-infection, as TB is the leading cause of death among people living with HIV.
When the health systems costs were factored in, plus the outcomes for patients receiving each test were considered, Xpert MTB-RIF was the most cost-effective tool for diagnosing TB. The costs were $850 for the current microscopy method, $879 for the culture method, and $809 for the method using Xpert MTB/RIF.
When we hear about diseases like TB, HIV/AIDS, malaria -- the big killers that take lives in the millions each year -- it's difficult sometimes to see the people whose experiences underlie the statistics. Alina is one of those people, and her story is emblematic of one of the greatest challenges we face in eliminating TB: She was denied access to the tools that could have saved her life, and for that she died.
Alina's mother told the BBC, "My daughter had a very short life and we do not want this to happen to any other child in any other family." Alina's mother has the compassion to think immediately about others -- and her request is within our reach.
Not only do we need more awareness about TB, so that lives like Alina's are not lost, we to invest in the very best life-saving technology.
Xpert is a game-changer in the fight against TB. Not because it is new, but because it saves lives.
What more could we want from $17 worth of technology?
Kolleen Bouchane is the Director of ACTION, a global partnership of advocacy organizations whose mission is to influence policy and mobilize resources to fight diseases of poverty and improve equitable access to health services. www.action.org
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