Revitalization of TB services in Libya following the COVID-19 pandemic

Libya

Photo: WHO Libya Ahmed Al-Mudbal

Revitalization of TB services in Libya

Tuberculosis (TB) has been prevalent in Libya for centuries, with an estimated 4,000 cases of TB occurring in 2021, an incidence of 59 cases for every 100 000 people [1]. Libya is categorized as a moderate TB burden country by the World Health Organization (WHO) and the WHO-recommended Directly Observed Treatment-short course (DOTS) has been deployed for TB patients in the country for two decades. The emergence of COVID-19 disrupted TB services in Libya and led to a decrease in the detection and treatment of TB cases. To address this issue, WHO Libya, in collaboration with the International Organization for Migration (IOM) and other partners, mobilized resources to holistically strengthen the management of TB services. Public sector TB services were re-activated and strengthened, resulting in increased health-seeking behaviour by the public and a corresponding increase in the notification of TB cases. TB new case notification declined from 2,209 in 2019 to 1,744 in 2020, before increasing again to 1,932 in 2021 across both host and migrant populations, including refugees [2, 3, 4].

Key WHO Contributions

Resource mobilization in collaboration with IOM to address the fall in TB services
Procurement of DR-TB drugs for distribution
Procurement of X-ray machines to increase diagnostic capacity
Conduct of trainings to healthcare professionals for improved management of TB
Advocacy and capacity building for journalists for greater awareness building.

How did Libya, with the support of the WHO Secretariat, achieve this?

TB is caused by bacteria (Mycobacterium tuberculosis), and it most often affects the lungs. TB is spread through the air when people with lung TB cough, sneeze, or spit. A person needs to inhale only a few germs to become infected and every year, 10 million people fall ill with TB [5]. The disease can be treated by standard six-month course of four antibiotics. Common drugs include rifampicin and isoniazid, but in some cases, the TB bacteria does not respond to the standard drugs. In this case, the patient has drug-resistant TB (DR-TB), treatment for which takes longer and is more complex [5].

As the COVID-19 pandemic took hold, health services across Libya became severely disrupted, including for TB. Lockdowns led to reduced health seeking behaviour along with cessation of outreach campaigns which would normally seek out and diagnose TB patients. Laboratories previously used for TB diagnoses were repurposed to cater for COVID-19 testing, further limiting access to TB services and as a result, TB diagnostic services decreased. Overall, TB notification declined from 2,209 in 2019 to 1,748 in 2020, a reduction of nearly 20% [2, 3]. Libya is particularly vulnerable to the risk of infectious diseases such as TB, as the country hosts more than 570,000 migrants, many of them living in unsanitary and crowded conditions which can easily lead to disease transmission. Many of the migrants are from TB-endemic countries, further increasing the risk of spread in both migrant and host populations.

^{Dr Mohsen Issa Aljawhery checking lung x-rays.}Photo credit: WHO Libya 2022 .

In recognition of this, WHO Libya along with IOM sought support from the European Union (EU) to a tune of €3.3 million to strengthen TB screening, laboratory diagnosis, referral and treatment services for migrants, refugees, internally displaced people, and other vulnerable populations. Specifically, WHO Libya in collaboration with IOM and both the Libyan Thoracic Society and Tripoli Medical University trained 277 healthcare workers on TB prevention and care and an additional 110 healthcare workers were given on-the-job-training. WHO Libya contextualized the materials for these trainings and developed a practical guide for the comprehensive management of TB based on latest WHO guidance. WHO Libya, together with headquarters and the regional office of the Eastern Mediterranean, also conducted a workshop for 25 professionals working for the national TB programme to scale up TB preventative treatments for vulnerable population groups such as refugees and migrants.

‘The National TB Programme highly appreciates the support provided by WHO Libya, which had a positive impact in increasing the detection rate of TB cases and the treatment success rate. The technical support for the development of the treatment guide in Arabic and English and subsequent support are undoubtedly adding value to the national efforts to combat TB across the country.’

Dr Mohamed Al-Furjani, Director of the National TB programme at NCDC Libya

With the support to the EU, WHO Libya was able to procure 50 patient course of oral DR-TB drugs which were delivered to TB treatment facilities in Tripoli and Benghazi. Three state-of-the-art portable X-ray machines were sourced and provided to the National Centres for Disease Control (NCDC) in Tripoli, Benghazi, and Tobruk to facilitate the rapid diagnosis of TB patients. To compliment this support, a network of 54 national print, radio and TV journalists were trained to increase the awareness of TB through various available electronic and social media platforms. This enabled the dissemination of accurate, evidence-based information to counteract any misunderstandings on TB. In addition, thousands of print materials were also distributed to all health facilities across the country containing TB awareness messages to increase public awareness and to reduce the related stigma.

‘The portable X ray equipment, GeneXpert machine and GeneXpert cartridges provided by WHO are highly useful for early diagnosis of the TB patients in Al-Kuwaifiya hospital. We are thankful to WHO for providing these essential items to reduce the TB burden in the country.’

Dr Mohsen Issa Aljawhery, Internal Medicine and Respiratory Diseases, Al-Kuwaifiya Hospital, Benghazi

As a result of these activities, TB services have improved across the 26 specialised units in the country through enhanced diagnosis along with treatment delivery. The country’s TB notification increased to 1932 in 2021 from 1744 in 2020 [3, 4]. As WHO Libya has provided technical expertise to develop the TB national strategic plan 2023-2027, it will continue to build capacity of national staff and advocate for additional resources through multisectoral collaboration.

Revitalization of TB services in Libya following the COVID-19 pandemic

Key WHO Contributions

How did Libya, with the support of the WHO Secretariat, achieve this?

References