Countries provide successful model for massive tuberculosis treatment scale-up
Target to treat 800,000 patients and prevent emergence of incurable TB strains
10 May 2006 | Atlanta, USA - Findings from a series of projects have clearly demonstrated that multidrug-resistant tuberculosis (MDR-TB) can be effectively treated in low-income countries and also provide a solid foundation for rapidly expanding TB control programmes. The conclusions, released today, present a major rethink on the feasibility of addressing the threat of drug resistant TB in poor countries.
The new World Health Organization (WHO) guidelines, encompassing the lessons learnt from 46 projects, and implemented in 29 countries* since 2000, were released at a gathering of TB experts in Atlanta.
The successful strategies that form the 'Guidelines for Programmatic Management of Drug-Resistant TB' will underpin actions outlined in the Global Plan to Stop TB 2006-2015. The goal is to rapidly increase the number of MDR-TB patients treated during the next decade - from currently 16,000 patients - to a cumulative total of 800,000 treated patients. The guidelines give practical advice on how to provide treatment to patients with drug resistant TB, based on the best evidence available and with the best drugs.
"MDR-TB was once considered a death sentence for most patients in poor countries," said WHO Director-General, Dr LEE Jong-wook. "These evidence-based guidelines and their conclusions show that it is possible to develop effective and affordable ways to treat MDR-TB patients in poor countries."
WHO, together with the US Centers for Disease Control and Prevention (CDC), Task Force for Child Survival, Partners in Health and other leading agencies have played a vital role in recent years, in making sure MDR-TB is given a higher priority on international health agendas.
"Addressing MDR-TB has become a core focus of our work, and is now a key component in WHO's new Stop TB Strategy," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "Extreme drug resistant TB bugs pose a mortal danger to control in many countries, and treatment programmes need to be scaled up as fast as possible to counteract this threat." In March, CDC and WHO published a study documenting the emergence of "extensively drug-resistant" strains of tuberculosis, termed XDR-TB, which are resistant to at least three of the six classes of existing second-line drugs and therefore incurable in most settings. Officials at today's meeting again warned that such extremely drug-resistant strains will multiply unless effective treatment of MDR-TB is vastly expanded.
MDR-TB has been detected in every region of the world with the highest rates found in countries of the former Soviet Union and provinces in China. WHO estimates more than 425,000 MDR-TB cases emerge every year, and global preva¬lence may be as high as one million cases.
Also included in the booklet is information on the 'Green Light Committee', which has been instrumental in providing access to these anti-TB drugs at vastly reduced prices, in some cases reduced by more than 90%. Its pivotal role has been recognised by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and in April 2006, WHO welcomed the Fund's decision to offer a financial 'lifeline' to the Committee.
However, there are still concerns that the Green Light Committee remains under-funded. Around 120 TB experts in Atlanta called for the Committee to receive increased resources as part of the strategy to successfully scale up patient treatments.
* Azerbaijan, Bolivia, Burkina Faso, Costa Rica, Dominican Republic, Egypt, El Salvador, Estonia, Georgia, Haiti, Honduras, India, Jordan, Kenya, Kyrgyzstan, Latvia, Lebanon, Mexico, Moldova, Nepal, Nicaragua, Peru, Philippines, Romania, Russian Federation, Syria, Timor Leste, Tunisia, Uzbekistan