BARCELONA/NEW YORK—Outdated policies and practices and critical gaps in care for drug-resistant tuberculosis (DR-TB) are fueling a worldwide public health crisis, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in a new report, Out of Step, released today at the 45th Union World Conference on Lung Health. Based on a survey of eight high TB-burden countries, MSF’s research reveals that efforts to control the epidemic are dangerously out of step with international recommendations and proven best practices, leaving drug resistant forms of TB to spread unabated. MSF warns that governments, donors, and industry must act now, using every means available, to step-up the response to the crisis, or face a further growth in resistance.
“This is no time for complacency: in some former Soviet Union states, MSF diagnoses multi-drug resistant TB (MDR-TB) in more than one in three people who have never been treated for TB before, indicating its spread from person to person,” said Dr. Petros Isaakidis, medical epidemiologist/senior operational research fellow, MSF India. “In Mumbai, India, MSF sees that primary transmission of drug-resistant strains is likely driving the epidemic in hot spots like slums and within vulnerable groups such as people living with HIV. DR-TB is a manmade disaster, born out of years of neglect and driven by a slow and piecemeal response. Countries must increase their efforts to optimize DR-TB care in line with international guidelines and seize the opportunity that new tools offer to strengthen and accelerate the fight against TB.”
The latest damning data from the World Health Organization shows that less than a third of the estimated MDR-TB patients worldwide are diagnosed, and only one in five receive proper treatment. Gaps in care fuel the spread of DR-TB from person to person; in some countries, MDR-TB is diagnosed in up to 35 percent of new TB patients, a trend reflected in MSF clinics.
The Out of Step report reveals five deadly gaps in the TB response that are costing lives: poor access to drug resistance testing, a growing number of people diagnosed with DR-TB left untreated, continued use of outmoded and costly models of care, limited access to promising new and repurposed drugs, and dire funding shortfalls.
MSF’s research found that testing for drug resistance, crucial for preventing misdiagnosis and incorrect treatment, is grossly insufficient in most of the countries surveyed. In half of the countries, fewer than 75 percent of MDR-TB patients diagnosed are enrolled in treatment. Further, some form of routine hospitalization takes place in half of the countries, despite community-based care having proven more tolerable for patients and more cost effective while delivering similar medical outcomes. Five out of eight National TB Programs face critical funding gaps, with Kenya, Myanmar, and Zimbabwe having less than 50 percent of the required funding available.
New and promising DR-TB drugs remain out of reach of most patients more than a year after their introduction, with bedaquiline and delamanid unavailable for routine use in all countries surveyed. In four of the countries surveyed, the new drugs are available to a limited few via compassionate use or equivalent programs. None of the countries have all of the Group 5 repurposed medicines listed in their national guidelines—drugs that are critically important in salvage therapies.
“Patients are missing out on the potential of new and promising treatments because companies and countries are dragging their feet with registrations. Meanwhile, the lack of clinical trials incorporating new TB drugs into much-needed short, tolerable, and effective regimens highlights the failings in the way medical innovation is conducted and incentivized. It’s time for TB research and development efforts to be prioritized and funded in a way that ensures lifesaving diagnostics and treatments rapidly reach the people who so desperately need them,” said Grania Brigden, MSF Access Campaign TB advisor.
MSF and Tuberculosis
MSF has been involved in tuberculosis (TB) care for 30 years, often working alongside national health authorities to treat patients in a wide variety of settings, including chronic conflict zones, urban slums, prisons, refugee camps, and rural areas. MSF’s first programs to treat multidrug-resistant TB opened in 1999, and the organization is now one of the largest NGO treatment providers of drug-resistant TB. In 2013, MSF treated 29,900 TB patients worldwide, including 1,950 patients with drug-resistant TB.