Although the capacity to diagnose multidrug-resistant tuberculosis (MDR-TB) has improved with new molecular techniques, but the treatment regimen for the more than 500,000 MDR-TB patients diagnosed each year remains where it was. The current internationally recommended regimen is long, expensive, and toxic and usually has a success rate of only 55%. A nine-month “short-course” treatment regimen has demonstrated a more than 90% success rate in several pilot studies, but policy-makers and donors are reluctant to endorse it. Thus even as more appropriate and affordable treatment regimens are critically needed, opinion on the best approach remains divided. Those working in the field are increasingly impatient with this stalemate, which is costing lives and enabling ever-deadlier strains of TB to evolve.
Cameroon is one of the countries that has tested the short-course MDR-TB treatment regimen with great success. In addition to a better than 90% cure rate, there were no treatment failures and no relapses. One factor contributing to this success is that this treatment is easier on both-- patients as well as health care systems. The cost is also dramatically less. Other countries that will present similar results at the workshop are Bangladesh, Benin and Niger. To date, more than 500 patients have benefited from this short-course treatment.
One of the main concerns of the World Health Organization is that the new regimen has not been tested through a randomised clinical trial. But, then for that matter no existing MDR regimen has ever been tested this way, and recommendations rely only on experience from the field. So the goal of the workshop is to thrash out the well established dogmas about the short course regimen, which could prove to be the life saving straw for several patients inching towards imminent death. It also purports to discuss other issues about MDR-TB, including the continuing need for new drugs. A serious issue revolves around the ethical problems created when patients are diagnosed with a disease and treatments exist but are not available to them.
According to Dr Nils E Billo, Executive Director of The Union, “The purpose of the workshop is to air the issues and give national tuberculosis programmes the information they need to make the best decision for their patients about MDR-TB treatment. When international advisory bodies are slow to change, people in the field have to push, because they are the ones who are entrusted with patient care. They are drivers of knowledge, not just the recipients of wisdom and experience in public health”.
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: firstname.lastname@example.org, website: http://www.citizen-news.org)
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