Towards universal access to diagnosis and treatment of multidrug-resistant and extensively drug-resistant tuberculosis by 2015
WHO progress report 2011
As recently as 10 years ago, few options for treatment and care were available to those affected by multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB).a Later, accumulating evidence indicated that the programmatic management of M/XDR-TB was not only feasible but also cost effective. The World Health Organization (WHO) has recognized M/XDR-TB as a major challenge to be addressed as part of the Stop TB strategy, launched in 2006. In April 2009, WHO convened a ministerial meeting of countries with a high burden of MDR-TB in Beijing, China, paving the way in May 2009 for the 62nd World Health Assembly to adopt resolution WHA62.15 on prevention and control of MDR-TB and XDR-TB, urging Member States to take action on multiple fronts towards achieving universal access to diagnosis and treatment of M/XDR-TB by 2015.
Despite the important progress being made, severe bottlenecks are limiting the response to the M/XDR-TB epidemic. Indeed, only 10% (24 511/250 000) of the estimated MDR-TB cases among notified TB cases in 2009 in the high MDR-TB countries, and 11% (30 475/280 000) globally were enrolled on treatment. Some countries are making progress by implementing policy changes that rationalize the use of hospitals, such as South Africa, or treating patients through community-based models of care, such as the Philippines. However, diagnostic capacity remains limited. Furthermore, the price of some quality-assured second-line drugs has not fallen, and shortages of drugs still occur. Overall, there is recognition that the response to MDR-TB must be built across health systems, and corresponding plans have been made. Human and financial resources are grossly insufficient and frequently inadequate. If domestic funding is not urgently mobilized, The Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as UNITAID, may become the main – if not only – source of funding for programmatic management of MDR-TB in several countries, demonstrating that commitment in endemic countries and domestic funding are hardly mobilized for this public health priority.