Mozambique is among 14 countries most affected by tuberculosis (TB) in the world with 97,093 cases of multidrug resistant TB (MDR-TB) in 2020 and 12,400 TB-related deaths each year. Additionally, the World Health Organization along with Mozambique’s National TB Program, TB reference laboratory, and district administration are of the unanimous opinion that improving TB diagnosis is the area most in need for Mozambique’s TB response. Despite continual efforts from national actors in conjunction with over 20 years of technical assistance (TA), the epidemic persists with limited access to TB services including diagnostics. This led to an FHI 360 mission to engage with key stakeholders and explore new approaches toward improving access to TB services. Stakeholders came together on June 1, 2023 at an event called “New Tuberculosis Diagnostic and Surveillance Tools: At the Crossroads of Achieving Universal Health Coverage and Global Health Security” to discuss the use of new TB diagnostic tools to effectively combat TB. Attending organizations included local NGOs, the National TB Program (NTP), and the National Public Health Institute (INS) laboratory.
This discussion of new TB diagnostic and surveillance tools brought to light serious gaps in access to TB diagnostics. Together, primary TB stakeholders sharpened their recognition of essential roles and collaborative means to address diagnostic challenges. There was consensus that the newest technologies needed to be escalated to subnational levels to ensure universal access to TB diagnostics and overall universal health coverage (UHC). Using proven technologies more widely will put the country on the best foot to fight TB and improve access to diagnostics on the way to ensuring UHC. Currently, all new technologies used for TB diagnostics including artificial intelligence-assisted x-ray and pediatric TB testing of stool samples using GeneXpert are available in Mozambique. However, these technologies are mainly only available in the capital city and surrounding regions, limiting access to these technologies by those most in need in other locations. While there are 22 GeneXpert machines available in country, only seven are fully functional.
The event participants also identified the country’s most TB-affected and vulnerable regions, including in Gaza province and the most urgent needs to curb the current TB epidemic. Localization principles were emphasized as an integral part of TB technical assistance in Mozambique and essential to this is emphasizing local organizations’ leadership. For example, ADPP Mozambique, a local NGO, leads implementation in three technical areas (clinical work, diagnostics, and monitoring and evaluation) with FHI 360 supporting this work as a sub-awardee.
The stakeholders’ discussion culminated in identifying priorities that include addressing diagnostic access limitations, improving specimen transportation systems, and prioritizing the most vulnerable locations and populations to ensure that cases are diagnosed and timely treatment is initiated to reduce drug resistance and ensure rapid cure rates.