Tuberculosis

Stephen Mosley Excerpts

Wednesday 27th November 2013 Westminster Hall

[Stephen Mosley (City of Chester) (Con)]

I congratulate the hon. Member for Scunthorpe (Nic Dakin) on securing this debate on tuberculosis, a disease that 8.6 million people catch, and of which 1.3 million people die, every year. It is a huge issue.

I was fortunate enough to join the Results UK delegation to Zambia last year, when we examined the link between HIV and TB. We visited Lusaka central prison. I do not know whether you have ever been to a prison in central Africa, Mr Dobbin, but, a couple of months before we attended, the vice-president of Zambia, Guy Scott, visited another prison and described it as hell on earth. I must say I have never been anywhere like Lusaka central prison. It was shocking.

The prison was built by the colonial authorities in the 1920s to house between 180 and 200 prisoners. Now it houses almost 2,000. We were taken to cells no bigger than my bedroom at home. They were designed to sleep between six and 10 people, but now there are 80 to 100 prisoners locked in those rooms for up to 14 hours a day. I looked at the room and wondered how they even fitted so many people in it. Apparently the sleeping arrangement is to line up 12 people against the wall, who crouch down with their backs to it. They sit down and open their legs and the next 10 or 12 come and lie between their legs, and so on, to cram them into all the available space. Mattresses and blankets are completely lacking. The toilet facilities are completely inadequate for the number of prisoners, and an open drain or sewer, containing a disgusting-looking brown liquid, runs through the middle of the courtyard. Medical facilities are lacking—the site has no health clinic and sick prisoners lack medicine—and so is food. There is one basic meal a day, which is completely lacking in protein. It is fair to say that the conditions in the prison are not conducive to general health.

Catching TB should not be part of someone’s prison sentence, but in that prison it was. At one stage the TB infection rate was almost 100%. TB is one of the fastest-growing epidemics in sub-Saharan Africa’s prison populations. It presents a threat not only to the inmates but to the wider population, because the prisons act as a reservoir for TB. It gets into the wider community through visiting, staff visits and the fact that prisoners who leave have been inadequately treated. TB does not respect prison walls.

There was a bright spot to the visit. We were taken to the prison by the commissioner of prison services, who was very open, and keen for us to see the reality. Several hon. Members have mentioned TB REACH, and we were shown a project that it had set up in the prison together with the Centre for Infectious Disease Research in Zambia. That programme included TB and HIV screening, treatment, and the introduction of isolation cells for prisoners with multiple drug-resistant TB. A prisoners’ drama group had been organised to teach prisoners to look for the signs of TB and understand how important it is for those with the disease to make people aware of it and get the required treatment. The programme was massively successful. The TB infection rate was down to 30%. That is still huge, but it is an awful lot better than it had been a year before.

Early diagnosis and treatment are essential for the control of TB. As we saw in Zambia, TB REACH runs pretty much the only mechanism designed to target and treat the 3 million missing TB victims we have heard about. One of its advantages is that it can react very quickly. It can provide fast-track funding for projects, to get them up and running quickly—often within six months. It is also willing to fund new and innovative approaches. That is important, because organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria will fund projects only if they have been proved successful. They will not finance new ideas or do experimental things to see whether they will work.

We need new approaches. Many places that we visited in Zambia—whether clinics, hospitals, or community groups—were in isolated communities. There is a need for new, mobile technology, and we need to roll out new diagnostic tests. That can happen only when testing and experimentation has been carried out, and when an organisation such as TB REACH is willing to provide funding. We saw that process in action when we visited Kanyama clinic, run by the Zambia AIDS Related Tuberculosis Project. Like my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke), we saw the GeneXpert machine in action.

For hon. Members who do not know what the GeneXpert machine is, the relevant website describes it as follows:

“The GeneXpert System automates and integrates sample preparation, nucleic acid amplification, and detection of the target sequence in simple or complex samples using real-time Polymerase Chain Reaction”.

In basic terms, it is a diagnostic tool that can diagnose TB much more accurately than the use of a microscope, as well as more quickly—often within two hours. It can detect TB in HIV-positive patients too. That of course is a massive advantage in rural clinics, because people can have the test and wait for the result. At the clinic, people from the community were encouraged to become involved as volunteers and to help people by talking them through the process, the results, and what the treatment would entail, and by going out into communities to ensure that they continued taking the treatment in the weeks ahead.

The GeneXpert machine works well in some environments, but it is not perfect. It can be difficult to use in isolated rural areas, because it requires a constant electricity supply, so on our visit we looked at how alternative energy supplies such as solar power could be used to power medical equipment in rural areas.

On our visits to Kanyama clinic and Lusaka central prison we saw at first hand the effect of TB REACH projects—improving TB diagnosis and providing fast treatment. However, as we have heard from my right hon. Friend the Member for Arundel and South Downs (Nick Herbert), the project is time-limited, and new funding is required now that its grant is coming to an end. There is concern about how some of the projects can be integrated into national health care systems. TB REACH grants are for short periods, to get a new technique into use in a locality. For permanent solutions it is necessary to integrate an approach into the relevant national health scheme, or to reach a position where it can be funded by the global health fund or donor countries will be willing to continue to support it.

As we have heard, the majority of the TB burden is concentrated in countries that often receive less donor funding. Whether it is the burden of drug-resistant TB in eastern Europe, TB in prisons in Zambia, or the epidemic, on an enormous scale, in India, domestic Governments must step up their own response. The UK has a unique opportunity to use its global leadership position to call on those Governments to increase their investment in the fight against TB, especially given our strong links to southern Africa and India, which account for the greatest part of the missing 3 million—the ones missed by their health systems. TB is a global disease on which the UK can have an impact.

The Minister and DFID have done a fantastic job and have made Britain a world leader in the battle against malaria. The UK Government should also use their position to become a global leader in the fight against TB, which is another of the top infectious disease killers. Global political commitment to that fight has so far been missing.