Drug Resistant TB: Healthcare delayed is healthcare denied

Alice Tembe, CNS Correspondent, Swaziland
Photo credit: CNS  
Tuberculosis (TB), has been around for centuries, but drug resistant TB (DR-TB) seems to be a more recent development.  As defined by Dr Sarabjit S Chadha from the International Union against Tuberculosis and Lung Disease (The Union) in India, DR-TB occurs when a patient with TB is resistant to at least one main drug used to treat TB.

In our times, there are at least two levels of drug resistance-- the first one being Multi-Drug Resistant TB (MDR-TB) where a patient with TB is resistant to Rifampicin and Isoniazid—the two most powerful anti-TB drugs. The second one is Extremly Drug Resistant TB (XDR-TB) where a patient with TB is resistant to quinolones and second-line injectables, in addition to the resistance to Rifampicin and Isoniazid.

According to the World Health Organization Global TB Report of 2014, over 480,000 MDR-TB cases are diagnosed annually and about half of the patients die from it (210,000 deaths).  A doctor heading a non-state HIV and TB organization in Swaziland, Dr. Mbuso Dlamini*, explained that many of these deaths are unnecessary and can be prevented. He explained that the delay in diagnosing and properly treating DR-TB has cost many lives. In agreement with Dr. Chadha of The Union, Dr. Dlamini explained that from patient entry into healthcare, conventional sensitivity tests like sputum analysis and X-ray are used to diagnose and initiate a six month Directly Observed Treatment (DOTS) for TB. Usually, if the patient remains non responsive to treatment for at least two months, then only the MDR-TB diagnostic tests are initiated and patients are enrolled on eight months DOTS with additional injectable. The patient goes through almost these eight months of treatment before diagnosis and extension to XDR-TB treatment.

The time lapse from patient entry into healthcare and diagnosis to treatment of DR-TB is too long, Dr. Dlamini noted. Most patients suffer for way too long and half of them do not survive, as indicated by the WHO Global TB Report of 2014. In Swaziland, according to the Extended National Strategic Framework on HIV-AIDS 2014-2018, over 70% of patients with DR-TB already have aggravating conditions including HIV and diabetes. These immune-suppressant diseases increase treatment failure in TB patients. Dr. Dlamini explained that the introduction of GeneXpert machines, that can establish a point of care diagnosis of drug sensitive as well as drug resistant TB, is a huge accelerator for the WHO End TB Strategy. However, as expressed by Dr. Chadha, the cost of the equipment is a major hindrance toin the use of this new and efficient technology.

With supporting evidence that the GeneXpert increased Rifampicin resistant TB case detection by over fivefold compared to conventional sensitivity testing in India in 2014, there is a great need for the following actions to be put into motion:
  • Intense lobbying by governments, international organizations like WHO and the Union, non-state actors in the TB field and TB patients as the beneficiaries, towards pharmaceutical companies to lower the cost of the equipment for accessibility and affordability
  • International funding prioritization to focus on such a life saving measure that will also complement infection control and reduce the treatment failure rates among DR-TB patients
  • Governments need to influence allocation of national strategy budgets for early and accurate diagnosis of DR-TB, treatment of patients with appropriate drugs and support for adherence and infection control, Dr. Tim France a Global Health Commentator and Managing Director of Inis Communication, noted that this will increase the possibility of ending TB
  • The mobility of the GeneXpert to be able to provide services when the patient is outside the hospital can also increase case detection and minimize infection control, as expressed by Dr. Dlamini.
(Dr. Mbuso Dlamini is using a pseudo name to protect his identity)

Alice Tembe, Citizen News Service - CNS
11 July 2015