Key bottlenecks in M/XDR-TB control and patient care
Forecasting the control of MDR-TB epidemics
Surveillance data on TB provided by WHO and partners enable the future epidemic to be modelled. These data show, in this paper, that both prevention of MDR-TB (“turning off the tap” through improving basic TB control) and diagnosis and effective treatment of MDR-TB cases (reducing transmission in the community of drug-resistant strains) are necessary to reducing rates of MDR-TB in countries where MDR-TB is already established and the rate is high. This can be achieved with existing diagnostics and treatment regimens, but new technology and approaches to diagnosis and treatment are needed to reduce cases and deaths more quickly. There are at least four reasons to intensify case finding and treatment for MDR-TB in all countries: to give the best possible chance of cure to all patients, whether they have drug-susceptible or drug-resistant TB; to accelerate TB decline, and move as quickly as possible towards elimination; to prevent the build-up in populations of drug-resistant, latent infection; and to plan for worst outcomes in the face of uncertainty (be risk averse).