Alarm rings to contain drug-resistant TB

Shobha Shukla, Citizen News Service - CNS
Retrograde policies and practices and critical gaps in care for multidrug-resistant tuberculosis (MDR-TB) are fuelling a worldwide public health crisis, according to a new report, ‘Out of Step’, released today by Médecins Sans Frontières (MSF) at the 45th Union World Conference on Lung Health at Barcelona.

The report is based on a survey conducted by MSF, from March to July 2014 on 30 key indicators related to TB care, in eight countries: Brazil, India, Kenya, Myanmar, the Russian Federation, South Africa, Uzbekistan and Zimbabwe. It reveals five deadly gaps behind the MDR-TB crisis, as drug resistant forms of TB spread their tentacles:--

Diagnostic gaps
Laboratory-confirmed diagnosis is critical to reducing the number of people misdiagnosed and receiving wrong or inadequate treatment for undetected MDR-TB. But access to drug susceptibility testing (DST) for first-line and second-line TB drugs remains limited. In five out of the six countries that provided data on DST coverage, fewer than 40% of previously treated cases are tested for first-line DST and less than 15% of MDR-TB cases are tested for second-line DST.

Treatment gaps
In four of the eight countries, less than 75% of MDR-TB cases diagnosed were enrolled in treatment.

Outmoded models of care
Four out of eight countries still include some form of routine hospitalization for MDR-TB patients in their guidelines, despite the fact that ambulatory or community-based care models not only have similar outcomes to hospital based care but are also more cost-effective and more tolerable for the patient.

Limited access to new/repurposed drugs
New and promising MDR-TB drugs remain out of reach of most patients. Despite the recent approval of two new TB drugs—Bedaquiline and Delamanid, the countries surveyed have had limited access to only one of the new drugs, and even that through compassionate use or equivalent programmes. Six out of eight countries had the necessary regulations to allow patients to access new drugs via compassionate use or equivalent programmes. No country had all Group 5 repurposed medicines incorporated in their national essential medicines list. Group 5 drugs have unclear efficacy for TB, but are critically important as components of therapy for XDR-TB.

Five of the countries surveyed had funding gaps in their national TB programmes. The three low-income countries surveyed (Kenya, Myanmar and Zimbabwe) face the most severe funding gaps for their national TB programmes, with less than 50% of required funding available.

The latest data from the World Health Organization shows that of the 9 million people globally affected by TB in 2013, 480,000 were estimated to have MDR-TB, out of which only 136,000 (less than 33%) cases were diagnosed and only 20% put on treatment. Global cure rates for MDR-TB are 48%, dropping to 22% for XDR-TB.

In parts of Eastern Europe and Central Asia MDR-TB rates in re-treatment cases are reaching 75%. Gaps in care fuel the primary transmission of MDR-TB from person to person-- in some countries, MDR-TB is diagnosed in up to 35% of new TB patients, a trend reflected in MSF clinics also. MSF warns that governments, donors and industry must act now, using every means available, to step-up the response to the crisis, or face a further growth in resistance. 

“This is no time for complacency. In some former Soviet Union states, MSF diagnoses MDR-TB in more than one in three people who have never been treated for TB before, indicating its primary or direct transmission from one person to another. In Mumbai, India, MSF sees that primary transmission of drug-resistant strains is likely driving the epidemic in hot spots like slums and within vulnerable groups such as people living with HIV,” said Dr. Petros Isaakidis, Medical Epidemiologist/Senior Operational Research Fellow, MSF India.

Adoption by WHO member states of the ambitious new post 2015 Global TB Strategy has set the stage for an ambitious international response. Countries and global health actors at every level must step up their commitment and actions to take major strides in the fight against TB, and in particular to curb the global MDR-TB crisis. Industry must respond accordingly to the gravity of the situation and ensure that new and promising tools, notably improved treatments, are made available at affordable rates to those in need at the earliest.

“Patients are missing out on the potential of new and promising treatments because companies and countries are dragging their feet with registrations. Meanwhile, the lack of clinical trials incorporating new TB drugs into much-needed short, tolerable and effective regimens highlights the failings in the way medical innovation is conducted and incentivized.  It is time for TB research and development efforts to be prioritized and funded in a way that ensures lifesaving diagnostics and treatments rapidly reach the people who so desperately need them,” said Grania Brigden, MSF Access Campaign,TB Advisor.

Shobha Shukla, Citizen News Service (CNS) 
30 October 2014
(The author is the Managing Editor of Citizen News Service - CNS.
Lilly MDR TB Partnership is supporting CNS Correspondents' Team to provide thematic coverage from the 45th Union World Conference on Lung Health in Spain. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email:, website: