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Commentary: Coercive measures to improve tuberculosis control may raise stigma to the disease — being more people-centred will help

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Mycobacterium tuberculosis — the bacterium that causes tuberculosis (TB) — is spread through the air via tiny droplets from persons with TB disease of the lungs.

At heart, the current strategy to eliminate TB worldwide involves early diagnosis and treatment of people with TB.

However, non-adherence carries a potential risk to both patients and the community in the form of higher rates of treatment failure, disease relapse, emergence of drug resistance, and renewed transmission of TB. As we mark World TB Day today, here’s an update on the local situation: TB is endemic in Singapore and TB infection is not uncommon in the population, with rates of up to 30 per cent in Singapore residents above 70 years of age.The incidence rate was 32.8 cases per 100,000 population in 2021, compared to 33.6 cases per 100,000 in 2020.

The TBDC also assesses the extenuating circumstances for the non-adherent persons before determining if recommendations should be made to MOH to compel these persons to complete their TB treatment under the Infectious Diseases Act . Singapore is not the first country to adopt such a legal approach towards TB treatment non-adherence. Many countries worldwide also have similar laws to compel TB treatment, including involuntary detention.

Involuntary detention for TB treatment further accentuates the difficulties experienced by these individuals and their households, especially if they are the main or sole breadwinners.

 

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