Addressing Tuberculosis, Diabetes, and Drug Overdoses Globally: Community-Informed Solutions

Although tuberculosis (TB) has had a cure since 1948, there were an estimated 10.4 million new cases of TB in 2015 [1]. TB, the leading infectious killer of adults in the world, claimed the lives of over 1.8 million people in 2015- that’s roughly 4,000 people every day dying from a preventable, curable disease. It is unacceptable.

Michael Wilson, MPH, BS, AA&D Partnerships Lead

The Zero TB Initiative (ZTB) was launched in 2015 and is designed to support cities, regions, and districts that are committed to achieving a rapid reductions in the number of people suffering from tuberculosis (TB). Advance Access & Delivery (AA&D) launched this initiative alongside partners from the Stop TB Partnership at the United Nations, the Department of Global Health and Social Medicine at Harvard Medical School, and Interactive Research and Development (IRD).

With flagship sites in Lima, Peru (population: 10 million), Karachi, Pakistan (population: 20 million) and Chennai, India (population: 8 million), the initiative is supporting networks of NGOs, government partners, private foundations, and local health providers in Durban, South Africa and Ho Chi Minh City, Vietnam to launch similar initiatives aimed at creating “islands of TB elimination” on the condition that they provide care according to the highest scientific standards. Rather than lowering standards based on allegedly static resource availability, AA&D is reaching for a level of care that citizens of high-income societies in North America and Europe  have come to expect when an infectious disease outbreak occurs. Even when resources seems scarce or non-existent to tackle a tough new challenge, if someone lays out a clear path based on science, it should not be surprising that new resources suddenly appear.

While initially the program focus is TB, it is the hope of the Initiative and its partners that TB will serve as a wedge into the community in terms of screening and treatment for multiple disease areas.  Specifically, the diabetes-TB co-epidemic is one of significant concern in many countries, including South Africa and India. Recent scientific studies have reported that over 8% of TB cases in South Africa were attributed to diabetes [2] [3] [4]. To tackle these and other pressing issues affecting patients with TB, AA&D is working alongside civil society, as well as public and private sector actors in Durban, South Africa and Chennai, India to apply lessons learned from TB and HIV detection and treatment programs to diabetes and other pressing communicable and non-communicable diseases. This type of integrated approach, while challenging in urban settings, relies heavily on building capacity at the community health level, leveraging the strength of nurses, community health workers, and social workers. At many of the community health centers that the ZTB project is working in, nurse managers and the teams they oversee are absolutely critical in ensuring seamless integration of services across disease areas.

The second area of work that AA&D is involved with is harm reduction for the economically and socially marginalized – currently focused on increasing access to a life saving opiate antidote called Naloxone. With the U.S. facing an overwhelming epidemic of deaths from opioid overdose, harm reduction coalitions across the U.S. are joining forces to expand access to this life-saving therapy. For decades, Naloxone has been reserved for use among paramedics and emergency room doctors, but widespread legislation has recently made it legal for laypersons to carry and administer [5]. Drug overdose situations are often a life-or-death situation and having this medication in the hands of the right people is absolutely critical to saving lives.

While several states have taken strides in increasing access to Naloxone by passing standing orders which allow for the dispensing of Naloxone without a prescription, price remains a huge barrier to widespread access to the individuals and communities that need it the most. AA&D is working alongside partners at the Chicago Recovery Alliance, the North Carolina Harm Reduction Coalition, and the UNC School of Pharmacy to look at ways pharmacists and other healthcare providers may play a role in increasing the availability and community-focused strategies to deliver Naloxone and other harm reduction practices in a timely, thoughtful way.

To learn more about Advance Access & Delivery (AA&D), please visit them on the web at

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