TUBERCULOSIS ACCESS ISSUES THE KEY CHALLENGES IN MDR-TB

UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012

UNITAID Technical Briefing65th World Health Assembly, 21st May 2012

Tuberculosis Access IssuesThe Key Challenges in MDR-TB

Paul Nunn Stop TB Dept., WHO


Definitions

• MDR (multi-drug resistance) = Resistance to at least INH and RIF

• XDR (eXtensively drug resistant) = MDR plus

resistance to fluoroquinolones, and one of the second-line injectable drugs (amikacin, kanamycin, or capreomycin)


Distribution of proportion of MDR among new TB cases, 1994-2010

0-<3

3-<6

6-<12

12-<18

>18

No data available

Subnational data only


Distribution of proportion of MDR among previously treated TB cases, 1994-2010

0-<6

6-<12

12-<30

30-<50

>50

No data available

Subnational data only

3.6% of all TB, but rising in many countries


Challenge 1 – Very few patients are treated

387

13

40

440,000 estimated cases

Treated in WHO/ Green Light Committee programmes

Countries report treatment, standard unknown

No treatment reported. Some treatment probably obtained, quality unknown

MDR-TB treatment levels compared to estimated burden in 2010


Challenge 2 - A "Catch 22"

• A course of SLDs is prohibitively expensive

• Because the market for SLDs is tiny

$20 for a course of first line treatment

$4000 for a course of 2nd line treatment


Challenge 3 – Finance insufficient

• Global Plan 2011-2015– $1.3 billion per year rising to $4.4 billion

• In many high MDR-TB burden countries cost of treatment exceeds annual GDP per caput

• Donor funding for 2011 $0.14 billion


Challenge 4 – Weak systems for management and regulation

• Access to MDR-TB care is limited in the public sector• Care is often sought from untrained providers who

do not follow international standards• Second-line drugs not internationally quality assured

and purchase unregulated in many countries (exceptions – Brazil and South Africa)

• Weak infection control practices in care facilities• Shortages of trained staff• Infectious patients remain in community


Challenge 5 – Access to diagnosis

• Laboratories capable of drug susceptibility testing are few

• Classical methods of diagnosis take 3 months or more

• New, rapid molecular tests expensive and rolling out, but slowly


, soThere are solutions to all these challenges

TUBERCULOSIS ACCESS ISSUES THE KEY CHALLENGES IN MDR-TB

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