LE METROPOLIS: Professor, what is the current state of tuberculosis in the Republic of Congo and what are the main challenges facing the PNLT?

Professor Franck-Hardain Okembaokombi : Tuberculosis remains a major public health problem in the Republic of Congo. Thanks to the joint efforts of the Government, the Ministry of Health and Population, and our partners, particularly the Global Fund, of which UNDP is the main beneficiary, significant progress has been made.

The Republic of Congo now has a more solid foundation to achieve the objectives of the End TB strategy.

Between 2016 and 2025, the incidence fell from 379 to 302 cases per 100,000 inhabitants, which reflects an encouraging trend.

However, disease transmission remains active and several challenges persist. We are seeing improved case reporting, although a significant number of infected individuals still go undetected by the healthcare system. Bacteriologically confirmed pulmonary forms remain the primary source of community transmission. Tuberculosis-HIV coinfection remains common, despite improved integration of care services.

From a diagnostic standpoint, the introduction of the Xpert MTB/RIF molecular test as a first-line examination and the progressive strengthening of the laboratory network represent major advances. Therapeutic outcomes are also improving and are now approaching the performance levels observed in the sub-region.

However, several challenges remain: screening is still insufficient, with more than 30% of estimated cases going undetected; access to quality diagnostics is still limited in some areas; the management of drug-resistant tuberculosis requires more technical and financial resources; mortality among TB-HIV co-infected patients remains high; and the digitalization of the surveillance system and continuing education for healthcare professionals need to be strengthened. Finally, program funding remains largely dependent on external partners.

The PNLT recently revised several national care guidelines. What are the main innovations introduced and what benefits can patients expect?

This revision was primarily aimed at aligning our national strategy with the latest recommendations from the World Health Organization. The new guidelines emphasize faster diagnosis through the expansion of the Xpert MTB/RIF test, improved management of drug-resistant forms with the gradual introduction of new molecules and shorter treatment courses, and a more patient-centered approach. We have also strengthened active case finding, systematic contact tracing, efforts to combat stigma, and the protection of patients' rights. Monitoring and evaluation tools have also been modernized to improve data quality and program management. For patients, these innovations should translate into earlier diagnosis, better-tolerated treatments, higher cure rates, reduced mortality, and decreased transmission of the disease within families and communities.

The End TB strategy entered its second phase in 2026. What conclusions can you draw from the first period (2015-2025) and what are the priorities of the PNLT (National Long-Term Expenditure Program) for 2035?

The review of our National Strategic Plan shows that the Republic of Congo made significant progress between 2015 and 2025. This achievement has been recognized by our technical and financial partners, including the WHO and the Global Fund. While not all the milestones set by the WHO have been met, the country now has a much stronger tuberculosis control system than in 2015. To achieve the 2035 targets, our priorities are clearly defined: to intensify early detection, strengthen prevention among vulnerable populations, facilitate access to shorter and more effective treatments, continue strengthening laboratories and the sample transport system, reduce the costs borne by households through effectively free healthcare, while further developing operational research and innovation.

Our ambition is to take full advantage of new diagnostic technologies, future vaccines and new treatments in order to accelerate the reduction in the incidence of tuberculosis.

What is your assessment of the partnership with the Global Fund in the fight against tuberculosis?

For more than twenty years, the Global Fund has been a strategic partner of the National Tuberculosis Control Program.

Its support has enabled the modernization of infrastructure, strengthened diagnostic capacities through the deployment of GeneXpert platforms, operationalized the P3 laboratory of the National Reference Laboratory for Mycobacteria, improved the supply of anti-tuberculosis drugs, and enhanced management of drug-resistant forms. The partnership has also fostered the development of community activities, active case finding, contact tracing, patient follow-up, and the integration of tuberculosis and HIV services.

Thanks to these investments, case detection has improved, treatment success rates have increased, and program governance has been strengthened. The main challenge now is to sustain these gains. Dependence on external funding remains significant. It will therefore be essential to gradually increase the government's contribution to ensure the long-term viability of the actions undertaken.

Drug-resistant tuberculosis is a growing threat. What is the situation in Congo?

The situation remains under control, but requires constant vigilance. Severe cases remain by far the most common.

However, cases of drug-resistant tuberculosis are regularly diagnosed, primarily in patients who have already received treatment or whose therapy has failed. Strengthened diagnostic capabilities now allow for much earlier diagnosis. The country now has 46 GeneXpert devices, 36 of which are operational, as well as Xpert MTB/XDR tests, capable of rapidly detecting resistance to the main drugs.

Care has also been decentralized across several departments to bring it closer to the population. The PNLT now implements the latest WHO recommendations.

with entirely oral treatments that are shorter and more effective, including bedaquiline when indicated. Beyond treatment, we place particular emphasis on the medical, biological, psychological, and social follow-up of patients to improve treatment adherence and prevent the development of new resistances.

How do you protect the most vulnerable populations, including children, adolescents, and people living with HIV?

Children represent almost 10% of reported cases, but their screening remains insufficient.

The program introduced a new diagnostic algorithm, notably using stool samples for young children, strengthened pediatrician training, developed active contact tracing, and expanded preventive treatment for exposed children. Regarding people living with HIV, our priority is systematic tuberculosis screening at every consultation, the integration of TB-HIV services within the same healthcare facilities, the rapid initiation of antiretroviral therapy, and the development of community-based follow-up. This integrated approach significantly improves the management of co-infected patients.

What role should communities, the media, and civil society play in this fight?

They play an absolutely essential role. Community actors are the first link between the health system and the population. They raise awareness, guide people with symptoms, support patients during their treatment, and help reduce stigma. The media also have a major responsibility. By disseminating reliable and accessible information, they promote early detection, combat misconceptions, and encourage behaviors that support prevention. The fight against tuberculosis cannot succeed without strong community mobilization.

In conclusion, what are the priorities of the PNLT for the coming years and what message would you like to send to the Congolese people?

Our priorities are clear: intensify screening, expand the GeneXpert network, strengthen contact tracing, improve the management of drug-resistant tuberculosis, further integrate HIV/TB services, develop community-based approaches, modernize our surveillance system and increase national funding to reduce our dependence on external partners.

I would like to remind all Congolese people that tuberculosis is curable when diagnosed and treated early. Anyone experiencing a persistent cough for more than two weeks, whether or not accompanied by fever, weight loss, or night sweats, should consult a health center promptly. Diagnosis and treatment for tuberculosis are free in our country. Combating this disease is a collective responsibility.

Together, by bringing together health authorities, healthcare professionals, technical partners, the media, community organizations and citizens, we can achieve the goal set by the End TB strategy: to make tuberculosis a disease that no longer poses a threat to public health.

ABOUT THE NATIONAL REFERENCE LABORATORY FOR MYCOBACTERIA (LNRM)

The laboratory, a pillar of the "End TB" strategy

Within the framework of the global "End TB" strategy, which places early diagnosis, detection of resistant strains, and technological innovation at the heart of the fight against tuberculosis, the National Reference Laboratory for Mycobacteria (LNRM) occupies a strategic position in the Republic of Congo. Under the supervision of the National Tuberculosis Control Program (PNLT), it forms the cornerstone of biological diagnosis and epidemiological surveillance of this disease.

The National Tuberculosis Reference Laboratory (LNRM) detects tuberculosis from a wide range of biological samples, including sputum, stool, cerebrospinal fluid (CSF), pleural fluid, lymph node aspirates, and other clinical specimens. It performs reference examinations based on the culture and identification of mycobacteria, as well as phenotypic and genotypic susceptibility testing for first- and second-line antituberculosis drugs. These advanced techniques enable the rapid diagnosis of drug-resistant forms and guide clinicians toward the most appropriate treatments.

The gradual introduction of molecular biology technologies, capable of detecting the presence of the tuberculosis bacillus within hours and identifying major drug resistances, has profoundly transformed patient care. As a reference laboratory, the LNRM ensures the validation of these new diagnostic methods, the ongoing training of laboratory staff, and continuous quality control. Beyond its diagnostic missions, the laboratory coordinates the national system for transporting biological samples, leads the implementation of quality assurance processes across the entire network of tuberculosis laboratories, organizes external quality assessment (EQA) activities, and monitors the evolution of resistance to antituberculosis drugs. It also plays a central role in the technical coordination, supervision, and capacity building of the national laboratory network, while providing the Ministry of Health and Population with essential scientific and strategic support for decision-making. Thanks to this expertise, the LNRM contributes not only to improving the speed and reliability of diagnosis, but also to optimizing therapeutic management, limiting the transmission of the disease, and providing health authorities with essential data to guide public policy. As the Republic of Congo fully commits to the second phase of the global "End TB" strategy (2026-2035), the laboratory appears more than ever as a crucial link in the national response to tuberculosis.