Addressing the Threat of Drug-Resistant Tuberculosis A Realistic Assessment of the Challenge: Workshop Summary (2009) / Chapter Skim
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8 Strategies for Confronting the Global MDR and XDR TB Crisis
8 Strategies for Confronting the Global MDR and XDR TB Crisis
Pages 97-108
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From page 97... ...
RECOMMENDATIONS PRESENTED by DR. kESHAvJEE Keshavjee summarized recommendations presented in a white paper commissioned for the workshop; the full text of the paper is presented in Appendix C
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From page 98... ...
• Priority must be given to research on -- and funding for -- the immediate devel opment and rapid deployment of point-of-care testing for drug-susceptible and drug-resistant tuberculosis. Drug Supply • WHO and international partners should take immediate and rapid steps to increase the number of manufacturers of quality-assured second-line anti t uberculosis drugs.
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From page 99... ...
At the same time, there is substantial untapped excess capacity for mycobacterial culture and DST in the developed world. One option would be to create a consortium of laboratories that could process samples from developing countries so that patients could begin receiving treatment while in-country laboratory capacity was being developed.
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From page 100... ...
If a patient cannot be immediately diagnosed with TB, an antibiotic trial with first-line antibiotics needs to be conducted; this is a common cause of delay for patients beginning treatment. Data from Rwanda show that antibiotic trials delay treatment on average by 39 days.
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From page 101... ...
In addition, a more transparent system for forecasting demand and a larger buffer stock of second-line TB drugs are needed to smooth out demand and supply, reducing risk for both programs and manufacturers. Currently, programs wait up to 6 months for drugs, keeping patients waiting, transmitting disease, and potentially dying.
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From page 102... ...
The critical need in this regard is human resource development planning at the global level that translates into regional and country-level capacity development that addresses both technical and managerial issues. Charles Wells of Otsuka Pharmaceutical Development and Commercialization suggested that the white paper expand on the need for the capacity of global programs to conduct clinical trials.
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From page 103... ...
Friedland offered a number of suggestions for reducing the impact of the TB epidemic: • A rapid and massive infusion of resources, • Enhanced epidemiological characterization, • Strengthened TB programs, • Integration of TB and HIV efforts, • Implementation of infection control strategies to reduce airborne transmission, • Improved TB and drug resistance diagnosis, and • Expansion of MDR and XDR TB treatment. Given the critical factor of immunosuppression due to HIV coinfection, Friedland suggested the need to continue to fast-track antiretroviral rollout
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From page 104... ...
This is already happening, he noted, in other areas of public health. For example, nine universities, civil society organizations, WHO, and the Italian government are leading an effort called Positive Synergies to examine how global health initiatives, such as PEPFAR, the Global Fund, and the Global Alliance for Vaccines and Immunization, can be harnessed to strengthen health systems.
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From page 105... ...
He noted that before the election, President Obama had expressed strong interest in reauthorization of the PEPFAR bill, which calls for $4 billion over 5 years to address TB. The legislation includes the requirement that USAID craft a plan and start setting targets to treat 90,000 MDR TB patients and 4.5 million standard TB patients.
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From page 106... ...
As noted, there is little grassroots activism for TB, and consequently there is inadequate political pressure to demand results. Yet Harrington believes that activism is needed at all levels -- increased scientific investment, strong political leadership, and greatly increased resources.
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From page 107... ...
Friedland added that there is substantial stigma associated with TB, HIV, and drug-resistant TB in most environments and cultures, and this has blunted the response both nationally and globally. Some of the populations that are at risk for and acquire drug-resistant TB by transmission or by treatment failure -- particularly in the former Soviet Union and in parts of Asia -- are themselves stigmatized because of issues of substance abuse or mental illness.
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From page 108... ...
Gandhi and Friedland demonstrated that XDR TB is not limited to KwaZulu-Natal, but has spread to most of its southern African neighbors. Despite these growing concerns, the diagnostic capabilities, resources, treatment and infection control policies, data collection mechanisms, and research capacity needed to understand and effectively manage this crisis still are not in place.
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