The head of the Stop TB Partnership talks to AlertNet about fighting drug-resistant tuberculosis in developing countries, the challenges of finding funding and particular problems affecting women with TB
By Astrid Zweynert
LONDON (AlertNet) – More people than ever are successfully treated for tuberculosis, one of the world's biggest killer diseases, but health experts are warning that drug-resistant forms of the contagious disease are spreading at an alarming rate.
Multi-drug resistant TB (MDR-TB) is spreading in particular in China, India, the Russian Federation and South Africa. It takes longer to treat with different kind of drugs, known as second-line drugs, which are more expensive and have more side effects. If these drugs do not work, extensively drug-resistant TB (XDR-TB) can develop with limited chances of treatment and cure.
AlertNet spoke to Lucica Ditiu, executive secretary at the Stop TB Partnership, about fighting drug-resistant tuberculosis in developing countries, the challenges of finding funding and particular problems affecting women with TB. The Stop TB Partnership is a network of international organisations, private and public sector donors, and governmental and nongovernmental organisations working together to eradicate the disease.
Tuberculosis killed 1.7 million people in 2009. Among the 15 countries with the highest estimated TB incidence rates, 13 are in Africa, while a third of all new cases are in India and China, according to the World Health Organisation (WHO). The WHO on Wednesday launched a new regional plan for Europe, where drug-resistant TB is spreading fast, to diagnose and treat the airborne infectious disease more effectively.
Q. What is the situation regarding MDR/MXDR tuberculosis in the developing world?
A: We’re speaking of 450,000 MDR/MXDR TB cases worldwide and most of them are coming from the 22 so-called high-burden countries.
In terms of estimated cases India, China and Russia are leading the number of cases for MDR- TB. Basically, if you address these three, and you also properly address the ones in the European region, you probably cover almost all MDR TB cases.
The difficulty with MDR-TB and XDR-TB is that we really don’t know very well how many we have, so we rely on estimates. For example, from the African region there are very few laboratories that are able to properly diagnose MDR and XDR-TB, so the number of cases coming from there so far is limited, and it might be limited because there are very few cases but it might also be limited because they don’t have proper access to proper diagnosis and that’s one of the things we’re looking into.
Q. In some of these countries the sheer size of the population can present a challenge in tackling the disease, for example, in India. How can this be tackled most effectively?
A: What is impressive is that both India and China very boldly decided to address this problem . Of course they have huge numbers and a lot of challenges but they’re trying to address it. India is preparing a plan that will run from 2012 to 2017 for all its TB programmes, it’s their five-year programme, which has a strong MDR-TB component with which they’re trying to ensure proper access to diagnosis and treatment. China hosted the first MDR TB meeting globally when the so-called Beijing Declaration to fight MDR- TB was launched. They took a lot of steps to address it and have included MDR-TB in the basic package of services that are offered to the population. These countries are moving forward, and I think it’s very important that countries are sharing what they do and learn from each other how to address it.
Q. Which regions are most at risk of not meeting the TB-related Millennium Development Goal (which aims to halt and begin to reverse the epidemic by 2015)?
A. We’re very worried about the African region. It’s worrying for many reasons: a big number of cases in the region, its pretty weak infrastructure, it’s the fact that we have a high co-infection rate between TB and HIV. For most of the patients a TB/HIV co-infection is really a huge life-threatening situation. And if it’s MDR-TB and HIV, it’s almost a death sentence. So, it looks like the African region will not meet the MDG goal on TB. Globally, it looks like we’re on track in reaching it and that’s pretty good. The European region is also somewhat borderline because of (the high incidence) of MDR- TB, especially in Eastern Europe. In Southeast Asia it’s about the fact that you have most of the patients treated in the private sector with doubtful quality of drugs, doubtful diagnosis, so how do you put that on track? If we put our heads together and push the African region to improve we might be able to reach the MDG overall.
Q. How acute is the funding shortage for treatment?
A. It is acute. For the first-line drugs I would say that it’s not that acute, in addition to the domestic funding. In TB there is this particularity that is interesting situation – a huge part of the funding comes from domestic resources. Internationally, a big chunk is coming from the Global Fund (about 81 per cent). The biggest challenge will be funding the second-line drugs (used to treat MDR-TB). They’re costing now globally an average $ 5,000/6,000 per course, which is huge. So, the money to cover the 440,000 MDR-TB cases that we know of globally - if we multiply this by 5,000 – it’s a huge figure. There are two paths that we want to take as an international TB community: one is to ensure that the funding will come, through the Global Fund and other donors and for that to be sustained and for governments to realise that their turn will come to put up this money. The other one is to ensure that the cost of drugs will go down, to reduce this cost of $5,000/6,000 per patient to a more reasonable amount, I would say $1,000 or less.
Q. In the past decade the number of HIV-positive women becoming ill with TB has increased, especially among those younger than 24 years. What needs to be done to stop this?
A. It’s worrying because women and children were not particularly looked at, not only when it comes to TB but regarding many other diseases as well. Especially with TB they have been neglected. TB is the biggest cause of death for women in Africa, surpassing even pregnancy-related deaths. We’re trying to emphasise this angle more. For example, we’re partnering with the U.N. Secretary-General’s initiative “Every Woman, Every Child” and trying to push TB up the agenda. The problem is that if you’re not looking at it in a comprehensive way, you’re creating health systems that are dealing with TB, dealing with HIV etc but the person that is sick is one and should be offered the range of services that is available, depending on the country’s budget. We launched an initiative called “Save a Million Lives” for TB/HIV, our official target is to save around 600,000 to 700,000 lives, together with UNAIDS, with what is available now between now and 2015. If we push a bit more we can actually a million lives, and a big part of that is women, and it’s just about integrating the two services – TB and HIV. The main challenges for women are lack of education and lack of access. Lack of education goes hand in hand for women to know their rights and responsibilities. It’s also about getting the diagnosis and the treatment point as close to the community as possible. Women very often don’t have any means to go to treatment centres. In most African countries to go for the diagnosis and have proper follow-up treatment is very hard for women. The tendency will be to drop the treatment.
READ MORE:
- Dangerous TB spreading at alarming rate in Europe
- FACTBOX: TB, a worldwide killer disease
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