In-depth: TB - the year that was

HEALTH: Progress on MDR-TB, but not enough

JOHANNESBURG, 24 March 2011 (PlusNews) - Gains have been made in stopping multidrug-resistant tuberculosis (MDR-TB), a largely undiagnosed killer, but not enough. By 2015 there will be two million new cases, says a new report by the World Health Organization (WHO).

MDR-TB is resistant to first-line TB drugs, such as isoniazid and rifampicin, while extensively drug-resistant TB (XDR-TB) is resistant to these drugs as well as at least half of the mostly commonly used second-line drugs.

In 2008, the latest year for which estimates are available, WHO put the number of MDR-TB cases at 440,000 globally, with 34 percent resulting in death.

In its new progress report, the organization charted gains made in the fight against drug-resistant TB, including increases in second-line drug availability, diagnostic capability, and national TB drug-resistance data.

Dr Ernesto Jaramillo, the WHO medical officer in charge of MDR-TB policy and author of the report, said the world was far from being on track to meet the 2015 deadline for universal access to diagnosis and treatment of resistant patients.

He stressed that MDR-TB was a complex issue, and cited a lack of funding, capacity and adequate staff in the 27 countries with a high MDR-TB burden.

WHO noted in its 127-page report that the Global Drug Facility, a WHO procurement mechanism, had improved access to drugs, and although the number of pharmaceutical companies supplying these drugs had tripled since 2008, it remains small.

National laboratory capabilities have also improved and all high- burdened countries can now conduct drug susceptibility tests to confirm MDR-TB at their larger reference laboratories, but point-of-care diagnostics are still scarce. WHO expects that by 2012, all high-burdened countries will have representative data on TB drug resistance to help guide their response.

In 2010, the Foundation for Innovative New Diagnostics (FIND) released the Xpert MTB/RIF TB point-of-care test, which detects TB and rifampicin resistance within two hours. The test is much more accurate than those previously available at district-level health centres, but at US$17,000 per unit the machine may prove too costly for widespread use in developing countries.

The report called for more funding for research into devices like this as well new treatments and vaccines. It also noted that a lack of such diagnostic tools may be partly why only about 10 percent of MDR-TB patients in high-burden countries are diagnosed, and only about 11 percent globally receive treatment.

DOTS - Directly Observed Treatment, in which patients are individually observed and supported to take TB medication daily - remains the cornerstone of TB and MDR-TB control, but Jaramillo said implementation was often hampered by poor health systems, which might mistakenly be using old TB thinking to treat a new drug-resistance threat.

“It’s like dealing with a new disease,” he told IRIN/PlusNews. “The only thing [MDR-TB] has in common with the old TB is the letters ‘T’ and ‘B’ - the drugs are new, the ways of monitoring patients are new, and the patients are more difficult to treat.”

Show me the money

Although countries have increased domestic funding for MDR-TB programmes, WHO and the Global Fund to Fight AIDS, TB and Malaria have warned that current allocations will be inadequate. WHO said an estimated $1 billion would be needed to fund the fight against MDR-TB by 2015 - about half current budget.

More on TB

Poor MDR-TB knowledge among nurses

Stigma holding back the fight against TB

New global plan aims to wipe out TB

Strike sends XDR-TB patients home

IRIN film - Drug-resistant TB

Contributions to the 2010 Global Fund replenishment fell short by an estimated $2billion, but it will still fund about 18 percent of the costs to control MDR-TB in 2011.

Some countries, like South Africa, the Russian Federation and Latvia, are likely to fund almost all of their MDR-TB response domestically, but the Fund may become the sole provider of second-line drugs and MDR-TB management in at least seven other high-burden countries.

“MDR-TB is a threat to all countries, as it is difficult and expensive to treat,” said Michel Kazatchkine, executive director of the Global Fund in a statement. “Unless we make an extraordinary effort to tackle this problem, our ability to finance and secure continued progress against TB in general will be threatened.”

Jaramillo noted that national economic decisions were often political ones, and urged civil society to keep the spotlight on TB as a top political priority in the worst affected countries.

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TB - the year that was March 2011
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	Neglected Diseases - Drug Resistant TB
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