Building Tuberculosis Treatment Capacity in the Time of COVID-19
Globally, COVID-19 has led to a rise in tuberculosis cases. Build Health International and Socios en Salud are working to reverse this in Peru by building a 3-story tuberculosis diagnostic and treatment hospital.
March 2020 marks the two year anniversary of when Peru recorded its first case of COVID-19. In that time Peru has experienced the highest rates of COVID-19 deaths per capita of any country, with over 6,500 COVID related deaths per 1 million people. While a keen and urgent focus has turned to combatting and controlling COVID-19 over the past two years, Peru has been battling another major respiratory epidemic for decades — tuberculosis.
As of 2020, Peru had the highest rate of tuberculosis and multidrug resistant tuberculosis (MDR-TB) of any country in the Americas, at a rate 53 times higher than in the United States.
Over the past two decades, Peru has made measurable progress in controlling, containing and treating the disease, a decline that mirrors the progress made to eradicate tuberculosis globally. With the introduction of COVID-19, however, 2020 was the first year in which year-over-year global tuberculosis deaths rose since 2005, as fewer patients sought, or were able to receive, treatment for tuberculosis care. While the extent to which tuberculosis will make a resurgence due to COVID-19 is still not fully understood, disruptions in health systems have caused TB notifications to decline by 80% in many low- and-middle-income countries. Without a diagnosis, patients afflicted with the disease are not able to access the life-saving care they need.
Despite the disruptions that COVID-19 has posed, Socios En Salud has remained steadfast in their mission to provide tuberculosis care and capacity, while also addressing COVID-19. Socios En Salud (SeS), Partners in Health’s sister organization headquartered in Lima, has been working to address TB and MDR-TB in Peru since 1996. Recognizing the barriers to care that COVID imposed, throughout the pandemic SeS deployed a fleet of vans equipped with X-Rays as part of their ‘TB Movil Project’. Entering into communities to perform chest scans that detect abnormalities and predict the likelihood of TB infection has allowed SeS to encourage TB screening to combat the declining rates of patients seeking treatment.
Socios En Salud is also taking strides to expand long-term tuberculosis care by partnering with Build Health International to construct a new Center for Global Health.. The Center for Global Health will be a 3-story diagnostic and treatment complex which will include a BSL-3 laboratory, pharmacy, and 21 patient beds.
The new center will enable Socios en Salud to not only provide a greater level of care to patients in need, but it will have increased research capacity to diagnose and study multi-drug-resistant and extensively drug-resistant tuberculosis within a new BSL-3 laboratory, the first of its kind in Peru. The Center’s location, in Carabayllo, Peru, on the northern outskirts of Lima, is particularly important, as 79% of MDR-TB cases in Peru occur in Lima.
While the Center for Global Health will play an essential role in expanding access to tuberculosis care, the design and construction of the facility is not an easy process. To design the center, BHI is working hand in hand with lab professionals who will be using the facility and local engineers who can advise on the area’s specific regulations.
The first challenge is the seismic considerations that play into building in an earthquake-prone area like Peru. Mikel Beaumont, one of BHI’s architects on the project, shares that because of Lima’s location near a fault line “everything is more heavily equipped than a building we would do somewhere else. We have concrete frames around the windows and there are a lot of considerations that go into making sure the building is safe and secure.”
As tuberculosis is highly contagious and easily transmitted, another key consideration is infection control. When designing the center, BHI architects need to ensure that contagious patients can be properly isolated, the BSL-3 laboratory is properly sealed, and the hospital’s overall flow is designed to ensure patients and staff are able to move about in a safe and intuitive manner.
“The considerations are everything”, shared Mikel. “Tuberculosis is ultra contagious so we have to consider air flow — when is the patient entering? How are the lab samples received? We need to make sure that nothing mixes and no contamination could occur.”
Once all thoughtful design considerations have been finalized, BHI will hire local contractors, who have experience building in the area, to complete the construction of the hospital. Design of the Center is set to wrap up in the next few weeks, with ground-breaking slated for August 2022.
When the Center for Global Health opens in early 2024, it will be a transformational resource in the effort to treat, control, and eliminate TB and MDR-TB in Peru. “The idea is to make this great complex where we can provide the best standard of care using all of our combined experiences,” says Dr. Leonid Lecca, a renowned tuberculosis expert and Executive Director of Socios En Salud. “We can then say to the world, ‘Here, all TB patients are cured. Here no patient abandons treatment.’”
Olivia Duggan is Build Health International’s Communication Manager. She writes about the intersections of health and infrastructure, with a focus on the impact of BHI’s work on fragile health systems.
