MDR-TB Crisis Highlights Gaps in Health Systems

By Chief K.Masimba Biriwasha | Global Editor-At-Large

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.

In fact, the 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, according to a statement by the medical humanitarian organisation Médecins Sans Frontières (MSF).

Alarming new data suggests that a concerted international effort is required to combat this deadlier form of the disease.Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to standard treatments using first-line drugs, MSF said. The deadly TB strain may develops due to insufficient medication or because patients miss some of their treatments.  It is difficult and takes much longer to treat – around two years, with highly toxic drugs.

Drug-resistant tuberculosis (DR-TB) develops 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.

Other factors known to have major impact on treatment adherence include social and economic factors, as well as weaknesses in the health care system itself. In most countries where there are high TB rates, health care systems are often in a shambolic state. This means that even ‘compliant’ patients are at a high risk of TB recurrence, as well as developing and transmitting drug resistant strains.

According to MSF, the global MDR-TB crisis coincides with a huge gap in access to diagnosis and treatment with nearly nine-five percent of TB patients lacking proper diagnosis.

“Existing diagnostic tools and medicines are outdated and hugely expensive, and inadequate funding threatens the further spread of the disease.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,” MSF said in the statement.

MSF President Dr. Unni Karunakara added that current knowledge about the extent of MDR-TB did not adequate capture the scope of the problem.

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,” he said.

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.”

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.

According to MSF, 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 affordability.  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 urged 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.”

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