Christopher, a 41-year-old fisherman, did not know why he was losing weight and unable to shake a persistent cough. Finally, he visited a health clinic in Tarawa, Kiribati, in October 2015 and received grim news: he had multidrug-resistant tuberculosis (MDR-TB), a type of the disease resistant to the two most powerful anti-TB drugs – rifampicin and isoniazid.
Great distances and limited resources complicate TB treatment in remote islands in the Pacific. MDR-TB poses even greater challenges since diagnosis and care are long, complex and costly. Drug resistance cannot be detected through traditional methods using microscopes, and most doctors lack experience in providing the complex treatment required. To make matters worse, the high cost and short shelf life of drugs needed often make it impractical to keep supplies on hand.
Christopher was saved thanks to key initiatives in the Pacific designed to support patients like him. His diagnosis was made in a matter of hours using a state-of-the-art rapid test. To support his treating physician, WHO organized a teleconference with the regional treatment group – connected remotely via Internet – of experienced TB clinicians, laboratory experts and public health consultants from Australia, Hawaii and WHO. The group provided the local health team with clinical advice on treatment, managing the side-effects and preventing the spread of the disease.
WHO also sent drugs from the Pacific TB drug stockpile at the Philippine Department of Health, so Christopher was able to start treatment just 17 days after being diagnosed. Additional drug susceptibility testing was carried out by a laboratory in Australia under the Pacific TB Laboratory (PATLAB) initiative. The results were used to adjust Christopher’s drug regimen to make it more effective. Today, Christopher says he is fully recovered and feeling fine.
Since 2011, the regional MDR-TB group, PATLAB and the Pacific TB drug stockpile have been meeting the needs of individual patients and TB programmes in Pacific island countries and areas. WHO manages these initiatives with financial support from donors. MDR-TB diagnosis and care in the Pacific presents major challenges for patients and health workers alike. These practical initiatives help overcome the challenges in providing the quality TB care each patient deserves.
Although TB incidence throughout the Western Pacific Region has decreased 14% over the past decade, an estimated 1.8 million people are newly infected every year in the Region. “The TB rate is coming down in the Region, but it’s not happening fast enough,” says Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “We need to do much more to achieve our goal of ending the epidemic once and for all.”