Methods such as hormonal implants and injections are reaching remote areas, providing more discretion and autonomy.On a busy day at the Kwapong Health Centre in rural Ghana, Beatrice Nyamekye put contraceptive implants into the arms of a half-dozen women, and gave eight or nine more a three-month hormonal injection to prevent pregnancy. A few sought condoms or birth control pills, but most wanted something longer lasting.“They like the implants and injections best of all,” said Ms. Nyamekye, a community health nurse. “It frees them from worry, and it is private. They don’t have to even discuss it with a husband or a partner.”The bustle at the Kwapong clinic is echoed all over Ghana, and across much of sub-Saharan Africa, where women have the world’s lowest rate of access to contraception: Just 26 percent of women of reproductive age in the region are using a modern contraceptive method — something other than the rhythm or withdrawal methods — according to the United Nations Population Fund, known as UNFPA, which works on reproductive and maternal health.But that is changing as more women have been able to get methods that give them a fast, affordable and discreet boost of reproductive autonomy. Over the past decade, the number of women in the region using modern contraception has nearly doubled to 66 million.“We’ve made progress, and it’s growing: You’re going to see huge numbers of women gaining access in the near future,” said Esi Asare Prah, who manages advocacy for the Ghana office of MSI, a reproductive health nonprofit.The Kwapong Health Center in Asunafo South.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

For seven years, Sulemana Musah put almost every bit of money that came his way into his war with hepatitis C.His student loans for graduate school, his salary from his job as a high school teacher and the cash he earned from a side gig selling yams all went to tests and medicines to try to cure the virus that debilitated him. Mr. Musah, 27, who lives in Accra, the capital of Ghana, set aside dreams of starting a business, building a house, getting married.He scraped together enough cash — $900, half his annual salary — to buy a course of the drugs that, a decade ago, began to revolutionize hepatitis C treatment in the United States and other high-income countries.He was the rare patient for whom that treatment wasn’t enough, so for years he tried, unsuccessfully, to save enough for another. “I was left just waiting for God to do his wonders,” he said.Then in March, his doctor gave him extraordinary news: The Ghanaian government had received a donation of medications for hepatitis C. He could have treatment for free. Within weeks, Mr. Musah had the pills. In October, a blood test showed he was cured at last.He was broke, exhausted — and ready to dust off his ambitions.The donation came from a most unlikely source: Egypt, which only a few years ago had the world’s highest burden of hepatitis C. An estimated one in 10 people, about nine million Egyptians, were chronically infected. In a public health campaign extraordinary for both its scale and its success, Egypt screened its entire population, brokered a deal for hugely discounted drugs and cured almost everyone with the virus.“This is one of the greatest accomplishments ever in public health,” said Dr. John W. Ward, the director of the Coalition for Global Hepatitis Elimination at the Task Force for Global Health.Mr. Musah, an economics teacher, received pills from a donation of medications given to the Ghanaian government. He sells yams to make ends meet.Egypt is on track to be the first country to achieve the World Health Organization goal of eliminating hepatitis C, and it is leveraging that victory into a campaign of “health diplomacy,” pledging to donate drugs and share expertise, with the goal of treating a million African patients. It is an unusual gesture in the world of global health, where largess is typically delivered to developing countries from high-income nations.“The Egyptian government saw an opportunity to extend its expertise beyond its borders and contribute to global health efforts,” said Khaled Ghaffar, Egypt’s minister of health and population. “This health diplomacy allows Egypt to leverage its success with hepatitis treatment for the greater benefit of humanity while simultaneously enhancing its standing among the global community.”Globally, about 58 million people are chronically infected with hepatitis C, according to the W.H.O., and the vast majority — 50 million — live in low- and middle-income countries. Four in five people don’t know they have the disease. About 300,000 people die each year of complications, particularly cirrhosis and liver cancer.The virus is most commonly transmitted by blood; in high-income nations, it is often spread by unsanitary needles used for injecting drugs, while in developing countries transmission frequently happens in health care settings, either through unsterilized needles and instruments or in cutting by traditional healers. About a third of people clear the infection on their own, but in most people, it becomes chronic, slowly damaging the liver over time.The waiting room of the hepatitis B and C infection clinic run by Dr. Yvonne Ayerki Nartey at Cape Coast Teaching Hospital in Ghana.Dr. Nartey, a physician at Cape Coast Teaching Hospital, joined the Coalition of Global Hepatitis Elimination to make a plan for Ghana’s new response.Yet few countries include the disease in their public health plans, or carry out testing to track the number of people infected. Hepatitis C has not been not the focus of any large international programs, the way H.I.V. and malaria are, and it has been such a low priority in low-income countries that governments rarely even track how many people have it, let alone treat it. Until this year, in Ghana as in other African countries, only a handful of wealthy people were accessing hepatitis C treatment, using drugs they purchased privately.The situation had been the same in Egypt until 2007. A mass vaccination campaign that began in the 1950s and for 20 years used improperly sterilized needles had accidentally spread hepatitis through the population. Few people could afford private treatment. When the government decided to start its national program, the virus was killing tens of thousands of people every year. At first, Egypt used two old drugs that only cured about half of those who were treated with them. But in 2013, Gilead Sciences Inc. brought to market an antiviral drug — the first cure for a viral infection in the history of medicine.While the company was charging $1,000 for its once-a-day pill in the United States, Egypt negotiated to buy it for $10 a pill — and then arranged for Indian and Egyptian drug companies to make an even cheaper generic version in exchange for a royalty. Egypt has treated more than four million people, and cut hepatitis C prevalence to just 0.4 percent.The Cape Coast fishing community in Ghana, about 90 miles southwest of Accra.Other companies soon followed with more antivirals; they have been highly effective, safe, and thus far not bedeviled by the drug-resistance problems that often plague antivirals.“The news on the drugs has only been good — the problem is that countries aren’t making the drugs available to the people in need,” said Dr. Ward, the coalition director.Egypt chose Ghana as an early partner because it is investing in building up national health care. Dr. Yvonne Ayerki Nartey, a physician at Cape Coast Teaching Hospital, joined the Coalition for Global Hepatitis Elimination to put together a plan for Ghana’s new response. She needed first to figure out how many Ghanaians were infected and where they were; a national screening effort found that one in 20 people in the north of the country, an area where poverty rates are higher and health services weaker, had hepatitis C. She went on radio shows and spread word through Facebook and WhatsApp that treatment might soon be accessible.Drugs were en route from Egypt, but the next step was tough: while a liver specialist would treat hepatitis in the United States, Ghana has fewer than 20 hepatologists. Dr. Nartey organized training courses for doctors in each district.“Most have never treated hepatitis C before because treatment doesn’t happen here,” she said.Dr. Nartey, with a patient at the hepatitis clinic in Cape Coast, Ghana.Cape Coast Teaching Hospital. Ghana has fewer than 20 hepatologists, and Dr. Yvonne Ayerki Nartey has organized training courses for doctors in each district.Most of the new treatment sites were teaching hospitals in regional centers, but she insisted on a pilot project at a rural hospital in an isolated region in the north, knowing that if Ghana was to truly wipe out the disease, frontline staff would have to be the ones to provide the treatment. The rural site had patients screened, tested and enrolled within a week.Testing remained a problem: only private laboratories offered the viral load tests that are necessary to track hepatitis treatment, and they charged several hundred dollars per test. Dr. Nartey has 340 patients enrolled for potential treatment, but only 290 of them have been able to raise the funds for the viral load test they need to start. The new hepatitis program negotiated a lower rate, promising a steady flow of patients, but at about $80 per test, it remains the biggest challenge to the program.For patients who had been living with not only the financial cost of the disease but also anxiety and fear as they saw relatives die of liver disease, the news of free treatment was almost unbelievable.Mr. Musah first began to feel ill as a high school student living in a small town in the north. The hospital near his home couldn’t explain his back pain and feverish nights, and tested for everything from a dairy allergy to syphilis to H.I.V. After hundreds of dollars in tests, he was finally given a hepatitis diagnosis — but was told he would need a specialty hospital to help him. He traveled to Accra, where doctors said there were drugs, but he would have to pay for them.A doctor noting Mr. Musah’s hepatitis C viral load; taking his blood; and tracking his expenses.In March, he joined other hepatitis patients at a celebration at a hotel in the capital where the Egyptian ambassador opened the free treatment program. But his challenges weren’t over. He needed the costly viral load tests to confirm the treatment was working; in September, he was faced with the choice of using a new student loan he took out to pay the tuition for a master’s degree, or for the test.In scaling up the program across Ghana, Dr. Nartey hopes to screen two million people with a cheaper antigen test, which costs about a dollar per patient, and then run the viral load for the 200,000 she anticipates will have the antibodies, confirming active infection, and end up with 46,000 patients who can be treated, using the first tranche of drugs promised by Egypt. Her prevalence survey suggests this will leave another 300,000 still to treat.“It’s a lot, but we’re ambitious,” she said.Egypt is working to set up parallel hepatitis C programs in other countries including Chad and Sudan.At the same time, Ghana is improving blood safety and injection practices, drawing on lessons from Egypt, and educating traditional healers, reducing the rate of new infections, Dr. Ward said.He hopes that if Ghana manages to scale up its hepatitis program, it will spur neighboring countries to start their own.“We have to get countries to realize the drugs exist and are so effective,” he said. ”We should be on a warpath to eliminate hepatitis C because it is so feasible.”Mr. Musah said that when he got the news he was finally virus-free, it was like the start of a whole new life: no more spending much of each day wondering how he could pay for drugs or tests, or if he could do it before the virus killed him.“Now I am free to plan a future,” he said.

At Kaneshie Polyclinic, a health center in a hardscrabble neighborhood of Accra, the capital of Ghana, there is a rule. Every patient who walks through the door — a woman in labor, a construction worker with an injury, a child with malaria — is screened for tuberculosis.This policy, a national one, is meant to address a tragic problem; two-thirds of the people in this country with tuberculosis don’t know they have it.Tuberculosis, which is preventable and curable, has reclaimed the title of the world’s leading infectious disease killer, after being supplanted from its long reign by Covid-19. But worldwide, 40 percent of people who are living with TB are untreated and undiagnosed, according to the World Health Organization. The disease killed 1.6 million people in 2021.The numbers are all the more troubling because this is a moment of great hope in the fight against TB: Significant innovations in diagnosing and treating it have started to reach developing countries, and clinical trial results show promise for a new vaccine. Infectious disease experts who have battled TB for decades express a new conviction that, with enough money and a commitment to bring those tools to neglected communities, TB could be nearly vanquished.“This is the best news we’ve seen in tuberculosis in decades,” said Puneet Dewan, an epidemiologist with the TB program at the Bill & Melinda Gates Foundation. “But there’s a gap between having an exciting pipeline and actually reaching people with those tools.”A recent visit to the Kaneshie clinic revealed both the progress and the remaining barriers. Despite the clinic’s policy of screening everyone for TB, which most often attacks the lungs, by asking a few questions about coughs and other symptoms, patients streamed into the single-story, cement-block building and were sent for care without any such queries. A member of the TB team, it turned out, was on holiday, another was on maternity leave and a third was out sick. That left just two, who were busy processing tests and doling out drugs.So no one was screened, not that day or any other day in the previous week.“It is a good policy, it works well when we can do it, but personnel is a problem,” said Haphsheitu Yahaya, the tuberculosis coordinator at the clinic.Richard Wonu, a radiographer, examined scans at the Kaneshie Polyclinic.A laboratory at the clinic.When the screening policy is working, new medications — the first to come to market since the 1970s — can be taken as just a couple of pills each day, rather than as handfuls of tablets and painful injections, the way TB treatments have been delivered in the past.Those diagnosed with drug-resistant TB receive medication to take for six months — a far shorter time than previously required. For decades, the standard treatment for drug-resistant TB was to take drugs daily for a year and a half, sometimes two years. Inevitably, many patients stopped taking the medicines before they were cured and ended up with more severe disease. The new drugs have far fewer onerous side effects than older medications, which could cause permanent deafness and psychiatric disorders. Such improvements help more people to continue taking the drugs, which is good for patients, and eases the strain on a fragile health system.In Ghana and most other countries with a high prevalence of TB, the drugs are paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international partnership that raises money to help countries fight the diseases. But contributions to the agency have been getting smaller with each funding round. Countries fighting TB are concerned about what may happen if that funding ends. Currently, the treatment for adults recommended by the W.H.O. costs at least $150 per patient in low- and middle-income countries.“If our patients had to pay, we would not have one single person taking treatment,” Ms. Yahaya said.Still, there has been progress in recent months in making the medicines more affordable, and prices may soon drop further. After prolonged pressure from patient advocacy groups, the United Nations and even the novelist John Green, who devoted his widely followed TikTok account to the issue, Johnson & Johnson has lowered the price of a key TB drug in developing countries. The company also agreed last month not to enforce a patent, which means generic drug companies in India and elsewhere will be able to make a significantly cheaper version of the medication.Richard Boadi, center, a nurse at the clinic, took notes on a possible tuberculosis case.A patient’s sputum sample was prepared for analysis.And for the first time in more than a hundred years, there is real hope for an effective vaccine: A promising candidate called M72, developed by the pharmaceutical company GSK with financial backing from the Gates Foundation and other philanthropies, is now in the last stage of clinical trials.(However, as ProPublica recently reported, it’s not clear who will have the rights to sell the vaccine, where it will be available and how much it will cost. Taxpayer and philanthropic money has paid for much of the vaccine’s development, but GSK retains control of critical components.)M72 is one of 17 vaccine candidates that are currently being tested in trials, providing a wellspring of possibilities. The only TB vaccine in use today was first given to people in 1921; it is helpful primarily for babies and does little to protect adolescents and adults, who account for more than 90 percent of TB transmission globally.Better technology to diagnose TB is slowly reaching clinics in developing countries. Clinics across South Asia and sub-Saharan Africa, including the one in Ghana, now have machinery to use rapid molecular diagnostic tests — equipment that was donated as part of the Covid response. That means that many health centers have finally stopped using an unreliable diagnostic method, developed in the 1800s, of viewing sputum smears under microscopes.Still, in 2021 only 38 percent of people diagnosed with TB were first given a molecular test; the rest were diagnosed with a microscope, or, in many cases, by their clinical symptoms.The molecular diagnosis can also spot drug-resistant TB right away. (The old method involved starting a person on a course of the most common drugs and waiting to see whether the treatment worked; if patients had the drug-resistant form of the disease, they just got sicker.)Joshua Dodoo, a driver, came to Kaneshie clinic in March with a lingering cough. He had been shedding pounds and couldn’t sleep. When he saw a doctor for what he thought was malaria, he was sent for a TB test. The one PCR machine in the clinic’s lab was in heavy use, so it was a few days before he learned from a nurse that he had TB.“I was so frightened,” Mr. Dodoo said, adding that he had not realized people still caught the disease.Mr. Boadi, left, gave instructions on how to use a sputum sample cup to Sadia Ribiro, center, and her husband, Joshua Dodoo, so that they could test their youngest child for TB.Mr. Dodoo’s and Ms. Ribiro’s children both developed coughs since their father was diagnosed with TB this year.His wife, Sadia Ribiro, was calmer and able to hear the nurse, Richard Boadi, explain that there is a cure, and that Mr. Dodoo would be given the treatment for free. Ms. Ribiro was tested; people living in close contact with a person who has TB account for a significant percentage of the 10.6 million new infections each year. She was negative, and was put on a course of preventive drugs for three months. These medications are new, too: Until recently, preventive therapy could take a year or more, and few patients finished it.But then, the system broke down. The couple’s two children, who are 3 and 11, were not screened. Mr. Dodoo said they were in school so it was difficult to bring them to the clinic, and they had seemed healthy. Then, even as he started regaining weight and feeling better, the children started coughing and complaining of fatigue.But they didn’t get a test until months later, when Mr. Boadi tracked then down at home. Only 30 percent of TB infections in children are diagnosed.Ms. Yahaya, the clinic director, said that, while preventive therapy worked remarkably well, the experience of Mr. Dodoo’s family was typical. People who are newly diagnosed don’t want anyone to know that they have the disease, which is associated with poverty and suffering, so they don’t volunteer information about other people who may have been infected. And the understaffed health system struggles to track them.Only 169 health centers across Ghana have the capacity to use the new testing method. Usually, samples must be sent away — up to a three-hour drive in some rural areas. By the time results come in, it can be hard to track down those who were tested.“The equation is simple: If we were putting more resources into testing for TB, we would be finding more TB,” said Dr. Yaw Adusi-Poku, who heads Ghana’s national TB control program.Ms. Gyan, a TB patient, picked up her drugs from the clinic. That will require more molecular testing sites, more staff members trained to spot the disease, more people to ask questions at the clinic door, more nurses like the intrepid Mr. Boadi, who turns up at his patients’ doors to encourage them to have their families tested (and who frequently digs into his own pocket to help patients pay for bus fare to pick up their drugs).Molecular diagnosis is considerably more expensive than the old method. Cepheid, the company that makes cartridges for the testing machines, recently agreed to cut the price of each one to $8 from $10. An analysis commissioned by Doctors Without Borders found that the cartridges could be made for under $5. Cepheid continues to charge $15 per test for the diagnosis of extremely drug-resistant TB, the most lethal form of the disease.Funding for TB services in low- and middle-income countries fell to $5.8 billion in 2022 from $6.4 billion in 2018, which is just half of what the W.H.O. says is needed. About $1 billion is available each year for TB research, half the amount that the United Nations says is required.At a special meeting on TB at the United Nations last month, governments committed to spending at least $22 billion a year on TB by 2027. But at a similar meeting in 2018, the same donors promised to spend $13 billion by 2022, less than half of which materialized.“I’m happy that we have these innovations, but the fact that they exist, that the W.H.O. recommends them, doesn’t mean people have access to them,” said Dr. Madhukar Pai, who leads the McGill International TB Centre at McGill University in Montreal. “The costs are still too high, and you need someone to deliver them.”

On a muggy evening in July on the island of Príncipe, part of a volcanic archipelago 200 miles off the West African mainland, 11,000 mosquitoes dusted in fluorescent green powder flew together into the heavy equatorial air, tiny volunteers in the service of science.Over the next 10 nights, another group of volunteers, human ones, sat outside their houses in villages nestled in the rainforest, keeping their arms and legs exposed in the damp dark, waiting for the faint tickle of a mosquito in search of blood. Once one alighted, they switched on a headlamp and used a rubber tube attached to a glass vial to suck the insect up and seal it in a cup.The mosquitoes were raised from larvae, dusted green, then set free, by an international team of scientists who are trying to bring cutting-edge genetic science to an ancient fight — that against malaria, the most deadly mosquito-borne disease.For each of the 10 mornings after the mosquito release, the scientists fanned out along the northeastern coast of this remote island, collecting cups humming with mosquitoes. They then took the insects to a makeshift lab in their hotel suite in the island’s one town, Santo Antonio, where they slid them under the light of a fluorescent microscope. Twelve of the 253 mosquitoes that had been caught glimmered with tiny particles of the green powder that clung to their scaly bodies.The recaptured green mosquitoes offered insight into how far they flew and the size of the mosquito population, clues to the dynamics of malaria in this country. And they moved the scientists one step closer to their goal: replacing the mosquitoes that live here now with ones they have genetically modified so that they can no longer transmit the malaria parasite.Their idea is to release a small colony of genetically modified mosquitoes, just the way they did with the green-dusted ones, to mate with wild ones. The gene engineering technology they are using could, in just a few generations — a matter of months when it comes to mosquitoes — make every member of the species that transmits malaria here, the Anopheles coluzzii, effectively immune to the parasite.This team, working with a project called the University of California Malaria Initiative, has already successfully engineered the Anopheles coluzzii to block the parasite in a lab. And the scientists believe they can harness gene drive, a process in which an inherited trait spreads swiftly throughout a population, so that all the species’s offspring will carry it, not just half, which is the way inheritance normally works.How scientists hope a gene drive could work