HEALTH EXPERTS HAVE expressed concern over “alarming” new data which shows that the scope of multi-drug resistant tuberculosis (MDR-TB) is wider than previously expected.
Less than five per cent of TB patients worldwide have proper access to diagnosis of drug resistance, according to Médecins Sans Frontièrs (MSF).
Meanwhile, just 10 per cent of MDR-TB patients are estimated to have access to treatment, with the fewest living in areas where prevalence is highest.
MSF says that existing diagnostic tools and medicines are “outdated and hugely expensive”, and that inadequate funding threatens the further spread of the devastating disease: ”With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most,” said MSF President Dr Unni Karunakara.
In Uzbekistan, 65 per cent of patients treated by MSF in 2011 were diagnosed with MDR-TB. The group confirmed the alarming statistic that, of those patients, 30-40 per cent had presented to the clinic for the first time – a percentage MSF described as an “unprecedented number globally”.
Similarly, in South Africa – a country with one of the highest cases of TB worldwide – MSF says it has seen a 211 per cent increase in TB diagnosis per month in its programme in KwaZulu Natal, following the introduction of a new rapid diagnostic test. Of those patients confirmed with TB, 13.2 per cent were resistant to the drug rifampicin, one of the most effective first-line drugs for treating TB.
The large numbers of first-time patients presenting with MDR-TB indicates that drug resistance is not only fuelled by incorrect treatment of TB but is also transmitting in its own right, according to MSF.
The group says that funding cuts, particularly the recent Global Fund cut, and prohibitively expensive drugs are exacerbating the already serious problem of MDR-TB. It also warns that “a small market with few manufacturers” has kept the costs of some of the drugs unreasonably high.
Over-the-counter drug sales and an unregulated private health sector continue to fuel the development of drug resistance in countries like India, where an estimated 99,000 people are infected with MDR-TB each year – and of whom only one per cent receive adequate treatment, it says.
Shorter and less toxic drug regimens are needed
It that the global crisis is exacerbated by lengthy treatment regimens (lasting around two years) using highly toxic drugs, “most of which were developed mid-last century and have unpleasant side effects”.
One of the stories on MSF’s TB&Me blogging platform, where patients from Armenia to South Africa are sharing their stories in their own words, MDR-TB suffer Mariam Davtyan describes the terrible side-effects she experienced while taking the drugs, saying she felt as if she was “passing through hell”:
I had hardly started the treatment when I began feeling terribly bad. After taking the drugs. I was vomiting, losing my appetite, couldn’t see or hear properly, had strange noises in my ears, felt a heaviness on my back, my heart was beating slowly and it was difficult for me to breathe.
I began to think I would lose my mind or would die.
MSF said that governments, international donors, and drug companies had to make new efforts to fight the spread of drug-resistant TB with new financing and moves to develop effective and affordable diagnostic tools and drugs.
It insisted that far shorter and less toxic drug regimens are needed, along with “currently non-existent” formulations for children, and a point-of-care diagnostics test. To prevent the further spread of the disease due to mismanagement by practitioners, regulatory measures also need to be enforced, it warned.