The social determinants of tuberculosis in the Philippines

The Philippines ranks fourth worldwide in tuberculosis incidence.1WHOGlobal tuberculosis report 2020.https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2020Date: Oct 14, 2020Date accessed: October 6, 2021Google Scholar About 1 million Filipinos have active tuberculosis, and nearly 70 Filipinos die every day from this curable disease.2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar Louisa Chenciner and colleagues (October, 2021)3Chenciner L Annerstedt KS Pescarini JM Wingfield T Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study.Lancet Glob Health. 2021; 9: e1380-e1390Google Scholar showed how health issues, such as HIV and illicit drug use, and socioeconomic factors, such as homelessness and low educational attainment, influence tuberculosis outcomes in Brazil. In the Philippines, where nearly 10 million people reside in urban slums,2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar social determinants are also major drivers of tuberculosis endemicity. The local 2019 TB Program Review2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar showed how vulnerable populations—the urban poor, people living with HIV, and people deprived of liberty—are more susceptible to infection and worse treatment outcomes. Notably, and in contrast to our local data, Chenciner and colleagues3Chenciner L Annerstedt KS Pescarini JM Wingfield T Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study.Lancet Glob Health. 2021; 9: e1380-e1390Google Scholar found incarceration to be a protective factor, possibly due to intensified directly observed therapy for tuberculosis in their studied prisons. Chenciner and colleagues3Chenciner L Annerstedt KS Pescarini JM Wingfield T Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study.Lancet Glob Health. 2021; 9: e1380-e1390Google Scholar paid particular attention to the adolescent and young adult populations (aged 10–24 years) with tuberculosis. Locally, Filipinos aged 0–24 years comprise a substantial proportion of the Filipino population with tuberculosis (27·3%). Additionally, Filipinos aged 10–24 years spend much of their time in crowded settings, such as schools, putting them at serious risk of spreading infection. Filipinos aged 10–24 have also been shown to be more likely to discontinue tuberculosis treatment than those older than 24 years.4Snow K Yadav R Denholm J Sawyer S Graham S Tuberculosis among children, adolescents and young adults in the Philippines: a surveillance report.Western Pac Surveill Response J. 2018; 9: 16-20Google Scholar Furthermore, young people have had the steepest rise in HIV infection in the country.2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar However, less than half of these people are on antiretroviral treatment, placing them at a much greater risk of developing tuberculosis than those who are on antiretroviral treatment.2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar Several initiatives have been launched in the Philippines to end tuberculosis: scaled-up screening in vulnerable communities and prisons in hyperendemic regions2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar and routine tuberculosis screening done for people living with HIV in treatment hubs.2Department of Health2019 Philippines TB joint program review. Department of Health, Manila2019Google Scholar 93% of the Philippines’ National TB Program5Department of HealthUpdated Philippine strategic TB elimination plan phase 1: 2020–2023.https://doh.gov.ph/node/24443Date: 2020Date accessed: October 6, 2021Google Scholar case notification targets have been achieved. However, the nearly-stagnant5Department of HealthUpdated Philippine strategic TB elimination plan phase 1: 2020–2023.https://doh.gov.ph/node/24443Date: 2020Date accessed: October 6, 2021Google Scholar incidence of tuberculosis in the Philippines highlights the complexity of this disease. To curb this trajectory, we strongly agree with Chenciner and colleagues’3Chenciner L Annerstedt KS Pescarini JM Wingfield T Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study.Lancet Glob Health. 2021; 9: e1380-e1390Google Scholar position that interventions must not only target screening, diagnosis, and treatment, but also adopt a nuanced grassroots approach that offers social protection among vulnerable and young populations. Interventions must be directed to populations most affected by tuberculosis: overcrowded slums, those living in poverty without access to education and health care, heavily-congested prisons, and young people living with HIV without access to antiretroviral treatment. Stakeholders must recognise that at the core of tuberculosis endemicity are the socioeconomic determinants of health, and addressing these determinants is the key to ending one of the biggest health problems in the country. JPAC currently serves as the vice president of the Philippine Radiation Oncology Society. All other authors declare no competing interests. Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort studyIn this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. 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