Alarming scale of multi drug – resistant tuberculosis requires rapid response to avert emerging global crisis

Alarming new data suggest that the global scope of multidrug-resistant tuberculosis (MDR-TB) is much more vast than previously estimated, requiring a concerted international effort to combat this deadlier form of the disease, the medical humanitarian organization Médecins Sans Frontières (MSF) announced today.

The global MDR-TB crisis coincides with a huge gap in access to diagnosis and treatment. Existing diagnostic tools and medicines are outdated and hugely expensive, and inadequate funding threatens the further spread of the disease. Worldwide, less than five percent of TB patients have access to proper diagnosis of drug resistance, and only 10 percent of MDR-TB patients are estimated to have access to treatment – far less in low-resource settings where prevalence is highest.

“Wherever we look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem,” said MSF President Dr. Unni Karunakara. “With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most.”

“There is growing concern over the spread of drug resistant TB throughout the Southern African region mainly because it often remains undiagnosed and untreated and thus continues to spread,” says Fasil Tezera, Head of Mission for MSF in Zimbabwe. “Although great gains have been made in HIV/AIDS programming over the last five years, HIV and HIV/TB co-infection remain an emergency in Zimbabwe.”

Drug-resistant tuberculosis (DR-TB) is difficult both to diagnose and to treat, and the Zimbabwean national TB programme is already stretched. The MSF team in Harare is providing support and technical assistance to health authorities in the implementation of a national DR-TB strategy. The organization has also supported a number of health institutions with the Xpert MTB/RIF machine, a laboratory based molecular test, which allows for rapid diagnosis of TB and resistance to rifampicin, one of the most potent first line drugs.

To respond to the medical needs in the country, MSF’s main focus is on providing a comprehensive package of quality HIV/TB services through an integration approach in Ministry of Health and Child Welfare structures. This package includes testing, diagnosis, treatment and counselling for HIV, TB, and DR-TB, as well as for other opportunistic infections.

“With the high co-infection rate and the growing emergence of drug-resistant TB, we need to change the way TB is treated. People need to be able to access diagnosis and treatment of HIV, TB and drug-resistant TB in the same facilities. In order to roll this out, treatment needs to be simplified and new models of care have to be implemented. A patient with drug-resistant TB can be treated at home, for instance, but it needs awareness and commitment,” says Tezera. “The key is that people need to be diagnosed early and treated properly so that resistance is not further spread.”

Data collected from MSF projects around the world have shocked doctors tackling the disease.

In the north of the Central Asian country of Uzbekistan, 65 percent of patients treated by MSF in 2011 were diagnosed with MDR-TB. Of those patients, 30-40 percent had presented to the MSF clinic for the first time, an unprecedented number globally – indicating that drug resistance is not only fuelled by incorrect treatment of TB, but is also transmitting in its own right.

In South Africa, where the TB burden is one of the highest worldwide, MSF has seen a 211 percent increase in TB diagnosis per month in its program in KwaZulu Natal, following the introduction of a new rapid diagnostic test. Of those patients confirmed with TB, 13.2 percent were resistant to the drug rifampicin, one of the most effective first-line drugs for treating TB.

In India, over-the-counter drug sales and an unregulated private health sector continue to fuel the development of drug resistance. An estimated 99,000 people are infected with MDR-TB each year, of whom only one percent receive adequate treatment.

In Myanmar, of an estimated 9,300 new cases of MDR-TB every year, so far just over 300 patients in total have received treatment. The cancellation of an entire round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine a five-year plan to reach a further 10,000 people living with MDR-TB in Myanmar, along with scale-up plans in many other countries.

The global crisis is exacerbated by a perfect storm of lengthy treatment regimens (around two years) with highly toxic drugs, most of which were developed mid-last century and have unpleasant side effects. Reduced funds—notably recent Global Fund cuts—and a small market with few manufacturers, have kept the costs of some of the drugs prohibitively expensive. Furthermore, expanded use of a new rapid diagnostic tool with the potential to massively increase early detection of drug-resistant TB in low-resource settings is inhibited by unaffordability. It is exactly in those places where the ability to detect TB within hours—as opposed to days or weeks—is most needed to save lives.

MSF is calling on governments, international donors, and drug companies to fight the spread of drug-resistant TB with new financing and new efforts to develop effective and affordable diagnostic tools and drugs. Far shorter and less toxic drug regimens are needed, along with currently non-existent formulations for children, and a point-of-care diagnostics test. Regulatory measures need to be enforced to prevent further spread of the disease due to mismanagement by practitioners.

“We need new drugs, new research, new programmes, and a new commitment from international donors and governments to tackle this deadly disease,” said Dr. Karunakara. “Only then, will more people be tested, treated and cured. The world can no longer sit back and ignore the threat of MDR-TB. We must act now.”


TB: Despite existing since antiquity, TB is the second biggest killer globally today – and there are more and more cases of TB resistant to first-line drugs normally used to treat it. Currently, an estimated 12 million people are living with TB (2010) – reference WHO Global TB Report 2011

MDR-TB: Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to standard treatments using first-line drugs. It is difficult and takes much longer to treat – around two years, with highly toxic drugs. Drug-resistant tuberculosis (DR-TB) developed during the treatment of drug-sensitive TB, when patients fail to complete their full course of treatment, drug supply interruptions, or when healthcare workers provide improper drug doses or improper, expired, or poor-quality medicine; and is now transmitting from person to person in its own right.

Funding cuts: Faced with a serious funding shortage after a disappointing replenishment conference, and after donors scaled back their pledges, the Global Fund to Fight AIDS, Tuberculosis, and Malaria took the unprecedented step in November 2011 of cancelling a round of funding grants. Without ‘Round 11’, no new grants for scale-up will be disbursed until 2014, leaving countries unable to aggressively tackle their epidemics. The cancellation of Global Fund Round 11 comes at a time when scale-up of DR-TB programmes is most needed.

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