TB in PNG

Burnet’s Dr Suman Majumdar has joined leading Australian tuberculosis physicians, Dr Ben Marais, Dr Justin Denholm and Professor Warwick Britton, in calling for urgent action to respond to the global challenge posed by drug-resistant tuberculosis (TB).

The Asia−Pacific region carries the bulk of the global TB burden (58 per cent), including the majority of all estimated multidrug-resistant (MDR) cases (54 per cent) (resistance to isoniazid and rifampicin)

Published in the Medical Journal of Australia (MJA), below is an excerpt of their compelling editorial, which highlights the urgent need for a collaborative regional leadership response. The complete editorial can be downloaded from the attached PDF.

Drug-resistant tuberculosis: collaborative regional leadership required

Success in stabilising the global tuberculosis (TB) epidemic is threatened by the emergence and spread of drug-resistant (DR) strains.

The DR-TB challenge is similar in scale and impact to HIV infection in the 1980s; however, the international response has been slow and insufficient.

Those worst affected by TB or DR-TB are from disadvantaged communities in low-income countries with little visibility or political influence.

The regional DR-TB challenge is daunting and needs to be tackled before it overwhelms health systems, as happened in some former Soviet Union countries. Visionary political leadership is urgently needed to champion a comprehensive regional strategy that draws on novel and creative solutions, similar to the Asia Pacific Leaders Malaria Alliance created to contain the emergence of drug-resistant malaria.

Four years ago, the World Health Assembly declared DR-TB a “global public health threat” and ministers from 22 high burden countries signed a “call to action”. This global resolution aimed to achieve universal access to diagnosis and treatment of DR-TB by 2015; but the response will fall well short.

The number of people living with MDR-TB has risen from an estimated 440 000 in 2008 to 680 000 in 2012, and less than 20 per cent receive appropriate treatment. These estimates are limited by insufficient laboratory capacity for drug-susceptibility testing and inaccurate reporting.

The existing tools to diagnose, treat and prevent DR-TB are inadequate and much more costly than for drug-susceptible TB.

Widespread rollout of the GeneXpert (Cepheid) test should improve the situation, but its impact will be limited in the absence of quality-assured laboratory infrastructure, shorter and more effective drug regimens and the scale-up of treatment programs for DR-TB.

Modelling studies show that if TB control strategies only focus on drug-susceptible disease, DR-TB will become the predominant strain. This is supported by new evidence showing that DR-TB has the potential for true epidemic spread in high burden settings.

Read the entire editorial…