Historic Opportunity to Tackle Drug-Resistant Tuberculosis at Risk

People Living with MDR-TB and Health Care Providers Call for Urgent Action

Two new drugs effective against multidrug-resistant tuberculosis must be introduced to improve treatment regimens in countries with a high burden of the devastating disease.

GENEVA/NEW YORK, MARCH 19, 2013—Two new drugs effective against multidrug-resistant tuberculosis (MDR-TB) must be introduced to improve treatment regimens in countries with a high burden of the devastating disease, a group of people living with MDR-TB and the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) announced in a public manifesto issued today.

Saw Naing from Myanmar was diagnosed with MDR-TB in October 2012. He is currently taking a cocktail of six drugs and is being closely monitored by Dr. Pyae Phyo Aung, in the MSF project in Yangon.

After close to five decades of insufficient research and development into TB, the new medicines—
bedaquiline and delamanid—have recently been or are about to be approved. Research is urgently required to determine the best way to use these new drugs so that treatment can be made shorter and more effective, and provided to the growing number of people with MDR-TB. If measures to tackle MDR-TB are not immediately expanded, rates of the disease will continue to increase worldwide, and a historic opportunity to improve abysmal cure rates will have been squandered, MSF warned.

People on MDR-TB treatment and their caregivers from around the world outline their demands in the "Test Me, Treat Me" manifesto, and urge others to join their call for urgent action.

“We have been waiting for half a century for new drugs that are effective against tuberculosis,” said Dr. Erkin Chinasylova, TB doctor for MSF in Swaziland. “Must we wait another 50 years to seize this historic opportunity to improve and roll out treatment for drug-resistant TB? Getting better treatment is beyond urgent, but we are not seeing anything like the level of prioritization required to make this a reality.”

Said-Hussein Sadulaev lives in the Russian Federation and was diagnosed with MDR-TB in August 2012. Said-Hussein was put on treatment by Dr. Satish Chandra Devkota, a Nepalese DR-TB doctor who’s been working in the MSF project for two years.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria provides about 90 percent of international support for TB, but it has recently reduced the share of funding to combat the disease. Donors must ensure the Fund is adequately financed at a key replenishment meeting later this year, so that countries have the support they need to strengthen MDR-TB responses, MSF said. With better treatments on the way, affected countries should scale up efforts to diagnose and treat MDR-TB today, so that robust programs are in place once the new drugs are introduced

MSF medical teams are witnessing unprecedented numbers of people with MDR-TB around the world, with drug resistance found not only among patients who have previously failed TB treatment, but also in patients newly diagnosed with TB, a signal that MDR-TB is being transmitted in its own right in the communities where MSF works.

Left untreated, the infectious disease is lethal. But current treatments, which include painful daily injections for up to eight months, can subject people to two years of excruciating side effects, including psychosis, deafness, and constant nausea. Barely half of those treated are cured.

“It’s 2013 and I’m beginning a fourth year of living with TB, when I should be in my fourth year at university,” said Phumeza Tisile, a 22-year-old woman who receives treatment for extensively drug-resistant TB from MSF in Khayelitsha, South Africa, and is one of the signatories of the manifesto. “I’ve swallowed around 20,000 pills and received over 200 daily painful injections since I started treatment in June 2010, and the drugs have left me deaf. I wish I could take just two tablets a day for a month or so and be cured.”

Phumeza Tisile, from Khayelitsha, South Africa, was diagnosed with MDR-TB in 2010; it was only after she’d gone deaf from treatment that she discovered that she had XDR-TB all along. She and her doctor Jennifer Hughes now communicate via text.

The number of people receiving MDR-TB treatment globally remains shockingly low, at less than one in five. Greater political and financial support from the international community is needed to address this gap.

“Right when TB should be the global priority, the trend we’re seeing is that it is being deprioritized,” said Dr. Manica Balasegaram, executive director of MSF’s Access Campaign. “This is unacceptable.”

Drug-resistant forms of TB are a neglected global health crisis: the World Health Organization estimates there were 630,000 cases of MDR-TB in 2011. MSF started providing treatment to people with MDR-TB in 2001. In 2011, MSF provided treatment to 1,300 people with MDR-TB in 21 countries.