Harare, Zimbabwe – Zimbabwe, like many countries across the world, is set to benefit from ongoing research into cheaper, quicker clinical responses to MDR-TB. Each year, 440,000 MDR-TB cases emerge and 150,000 people die. To prevent these unnecessary deaths, the International Union Against Tuberculosis and Lung Disease (the Union) programme, TREAT TB Initiative, is sponsoring a multi-country clinical trial – STREAM – which will evaluate a markedly shorter and more tolerable treatment regimen for MDR-TB.
In addition TREAT TB’s PROVE IT study is assessing the effectiveness of new diagnostic tools for TB through projects in Brazil, Russia and South Africa. Four countries in francophone Africa are also testing a nine-month MDR-TB treatment regimen with technical support from The Union. TB-HIV integrated care is also an important focus of The Union’s technical assistance, education and research. Its course on developing TB-HIV collaborative activities is increasingly in demand.
Multidrug-resistant TB (MDR-TB) is a form of TB that usually does not respond to the standard six-month treatment regimen using first line-drugs (i.e., it is resistant to isoniazid and rifampicin).
MDR-TB can take up to two years to treat with drugs that are more toxic than the standard drugs, and the treatment is 100 times more expensive. If the drugs to treat MDR-TB are mismanaged, further resistance can occur.
Drug resistance arises when TB treatment and other services do not work as intended and numerous critical factors such as rampant poverty, a crumbling health system, a lack of appropriate laboratory and diagnostic capacities, the movement of people including the brain drain of health workers, and limited TB funding, hamper TB control efforts.
Dr Anthony Harries, Senior Advisor and Director (Research) at The Union feels that an uncontrolled private sector, prescribing and selling TB drugs to people who can buy them over the counter, fuels the occurrence of MDR TB. According to him, “The global TB guidelines management of TB are excellent and if they are followed we should not be having any problem of drug resistant TB. But if there are unregulated practices it will encourage DR TB. the problem of drug resistant TB is bound to occur. For example, in some countries in South East Asia one can walk into a pharmacy and buy rifampycin for cough over the counter. If the cough is due to TB and one takes rifampycin for 7 days the TB germs will become resistant to rifampycin and this will be the beginning of MDR TB. Similarly the private sector in India offers innumerable different regimens to treat TB which is not good. So the private sector has to be controlled if it is there. Else the TB drugs will be abused and we will get this big problem of MDR TB. In Central Africa MDR TB is not a big issue because of tight government controls over the open market. We have lost that in Asia where rifampycin has not been protected and can be bought in the open market to treat not only cough but also skin diseases, STIs and diarrhoea.”
Recent drug resistance surveys have found high rates of MDR-TB in southern Africa, a region also heavily hit by the HIV/AIDS epidemic. This trend is increasing. MDR-TB has been shown to be almost twice as common in TB patients living with HIV as in those who are not infected with HIV. According to The Union’s forthcoming Guidelines for Clinical and Operational Management of Drug-Resistant Tuberculosis, preventing the spread of TB bacilli in health, congregate and other settings that may be frequented by PLHs is an essential step towards preventing drug-resistant TB.
“In fact, many experiences document how MDR- and XDR-TB thrive among people living with HIV (PLH). It follows that preventing the spread of TB bacilli in health, congregate and other settings that may be frequented by PLHs is an essential step towards preventing drug-resistant TB (DR-TB). There is no doubt that the combination of DR-TB and HIV infection puts patients at great risk: it is not only patients’ lives that are at risk due to sub-optimal treatment outcomes, but also general TB control activities face severe challenges in high HIV burden countries,” reads a statement from the Guidelines.
Chief K Masimba Biriwasha - CNS
(The author, born in Zimbabwe, is an Editor, a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)