- DST laboratories in India need to maintain their proficiency despite shortages of second-line drugs. (Neeraj Raizada, FIND)
ADDRESSING TB AND DRUG-RESISTANT TB
IN VULNERABLE POPULATIONS
Children, people infected with HIV, and migrant and refugee populations all are especially vulnerable to drug-resistant TB and can contribute to its spread. The incidence of drug-resistant TB in these populations remains unknown, especially among children, and this lack of information obscures the extent of the problem. But contact tracing has revealed large numbers of TB and MDR TB cases arising within and from these populations.
Another important vulnerable population, noted Gary Filerman, Atlas Health Foundation, is the prison population. Although the incarcerated and others in congregate settings were not discussed extensively at the workshop, Filerman and Keshavjee noted that the prison populations in almost every country have higher rates of TB and MDR TB than the general population and deserve special attention.
Conclusions and recommendations offered by individual workshop participants in the area of addressing TB and MDR TB in vulnerable populations included the following:
- The burden of drug-resistant TB in vulnerable populations needs to be documented. (Soumya Swaminathan, National Institute for Research in Tuberculosis)
- Better diagnostics are especially important for pediatric populations. (Swaminathan)
- New technologies that can deliver results of DST rapidly for children and people coinfected with HIV are a particular need. (Keshavjee)
- Shorter treatment regimens for MDR TB may be possible in children because of their lower bacillary burden, but clinical trials are needed to test this hypothesis. (Swaminathan)
- New drugs being developed for adult TB patients should be studied in children early in the development process so that pediatric populations can have access to these drugs as quickly as possible. (Swaminathan)
- The possibility of using first- and second-line drugs prophylactically to prevent TB infection in children and other vulnerable populations needs to be studied. (Swaminathan)
- Vulnerable populations and their contacts should be eligible for more aggressive testing. (Mercedes Becerra, Harvard Medical School)