A $15 million award has been made by the Global Fund against AIDS, TB and Malaria to the National Leprosy & TB Control Programme (Ministry of Health) and MRC (UK) The Gambia as co-principal recipients.
The five-year Round Nine grant will fund a package of activities aimed at increasing Directly Observed Treatment, Short-course (DOTS) coverage in the country, thereby reducing TB in The Gambia to levels where it is no longer of public health significance.

MRC (UK) The Gambia’s input will be focused on research that can better quantify the disease burden and interventions that will have significant impact on the prevalence of the disease in the country.

Phase 1 of the award will include surveys to get an accurate measure of The Gambia’s TB burden. Dr Ifedayo Adetifa (Principal Investigator, MRC (UK) The Gambia) said ‘This will enable more precise measurement of the National Leprosy & TB programme’s activities… The figure would also allow us to get a better estimate of TB incidence in the country – that is the number of new cases per year.’

The investigators also plan to do a survey on community transmission of TB using tuberculin skin tests on young children. Dr Adetifa said ‘It is known that TB infection in children – the quiet form of TB – gives you an insight into background transmission in the community. If it’s high then there are probably a lot of undetected TB cases in the community.’

A new TB case detection strategy will be trialed as part of the study: enhanced case finding. TB messages will be given to the community and sputum cups distributed at meetings. Dr Adetifa said ‘We’ll be looking to see whether this will have an impact on the number of cases identified. If this pilot is successful we hope it can be extended across the country.’

A new and improved form of sputum smear microscopy will also be rolled out for the first time in the West African sub-region during the first phase of the study. Dr Adetifa said ‘We’ll be helping the National Health Reference Laboratory to roll out fluorescent smear microscopy - said to be 10% more sensitive than light microscopy - in the greater Banjul area. If successful, this will be expanded to cover the entire country subsequently.’

At the end of five years, the National Leprosy & TB Control Programme and MRC (UK) The Gambia hope to see a significant drop in TB cases in the country. Dr Adetifa concluded ‘Then we would be part of another Gambian success story (along with Hib, Hepatitis B and other interventions tested in The Gambia)…We might just be the first country to test such an intervention on such a large scale and actually deliver it successfully.’