Tuberculosis Care and Doctors Without Borders/Médecins Sans Frontières (MSF)
March 18, 2004

MSF has been confronted with tuberculosis (TB) since its first day of operation more than 30 years ago. In the past few years, MSF has expanded TB treatment to include more patients, and the focus has shifted from disease control to patient care.

MSF presently treats approximately 20,000 patients for TB in 32 MSF projects in 17 countries, including Afghanistan, Angola, Burma, DRC, Ethiopia, Georgia, Guinea, India, Ivory Coast, Azerbaijan, Kenya, Malawi, Sudan, Somalia, Turkmenistan, Thailand and Uzbekistan.

In addition to treating patients in traditional developing country settings and TB programs, alternative models have been found to treat migrants or nomadic people who are extremely difficult to follow.

Fifteen MSF projects now treat TB patients in chronic conflicts, including work in Abkhazia, Afghanistan and in South Sudan. An increasing number of patients receive TB care through MSF in general health centers, e.g. in Afghanistan, South Sudan and Angola.

MSF recently completed the report Running out of breath? TB Care in the 21st Century, an examination of the shortcomings of the global TB strategy, and TB diagnostic tests and drugs. The report concludes:

Expanding the current WHO-recommended global TB strategy, DOTS, or Directly Observed Therapy - Short Course, is not the only answer to TB. Improving DOTS is key if we are going to try to effectively treat the growing number of TB patients.

Vigorous action for improved, more inclusive DOTS and for resources to develop new tools to fight TB is needed.

MSF recommends the following points for action:

Revision of the global TB strategy
WHO should lead the process of revising a global TB strategy that adequately addresses the HIV/AIDS pandemic and its consequences for TB care.

• Access to treatment for smear-negative patients must be ensured: program objectives need to be revised to eliminate perverse incentives to focus on subsets of patients.



• Innovative means of improving treatment adherence must be found, including reduced need for direct observation.



• More resources to develop new tools to fight TB adapted for resource-poor settings are urgently needed.

Boost development and validation of new diagnostic tools

• An emergency plan is needed to speed up validation of promising diagnostics.



• Ensure affordability of existing diagnostic and DST (e.g. MGIT).



• More R&D into entirely new TB diagnostic tools (e.g. antigen detection).
  
  

Quicken the pace of developing new, easier-to-use drugs and make them available at affordable prices

• WHO and governments must work together to develop and fund an essential TB clinical research agenda, ensuring that needed clinical trials take place. The agenda should consist of developing new TB treatments among:


   1. TB indications of existing drugs.
   2. New compounds.


• Governments should insist that companies make compounds with potential activity against TB available to those that are willing to develop them into drugs. When commercial interests hamper the development of a potential TB treatment, governments need to intervene.



• New TB drugs must be affordable to the people who need them.

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