TUBERCULOSIS ACCESS ISSUES THE KEY CHALLENGES IN MDR-TB

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Dr Paul Nunn, Coordinator, TB Operations and Coordination, World Health Organization

UNITAID Technical Briefing 65th World Health Assembly, 21st May 2012

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TUBERCULOSIS ACCESS ISSUES THE KEY CHALLENGES IN MDR-TB

  1. 1. UNITAID Technical Briefing 65th World Health Assembly, 21st May 2012 Tuberculosis Access Issues The Key Challenges in MDR-TB Paul Nunn Stop TB Dept., WHOUNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  2. 2. Definitions• MDR (multi-drug resistance) = Resistance to at least INH and RIF• XDR (eXtensively drug resistant) = MDR plus resistance to fluoroquinolones, and one of the second-line injectable drugs (amikacin, kanamycin, or capreomycin) UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  3. 3. Distribution of proportion of MDR among new TB cases, 1994-2010 0-<3 3-<6 6-<12 12-<18 >18 No data available Subnational data only UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  4. 4. Distribution of proportion of MDR among previously treated TB cases, 1994-2010 0-<6 6-<12 12-<30 30-<50 >50 No data available Subnational data only 3.6% of all TB, but rising in many countries UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  5. 5. UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  6. 6. Challenge 1 – Very few patients are treated MDR-TB treatment levels compared to estimated burden in 2010 No treatment reported. Some440,000 treatment probably obtained, qualityestimated 387 unknowncases Countries report treatment, standard unknown 40 13 Treated in WHO/ Green Light Committee programmes UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  7. 7. Challenge 2 - A "Catch 22" • A course of SLDs is prohibitively expensive • Because the market for SLDs is tiny $20 for a course of first line treatment $4000 for a course of 2nd line treatmentUNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  8. 8. Challenge 3 – Finance insufficient• Global Plan 2011-2015 – $1.3 billion per year rising to $4.4 billion• In many high MDR-TB burden countries cost of treatment exceeds annual GDP per caput• Donor funding for 2011 $0.14 billion UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  9. 9. Challenge 4 – Weak systems for management and regulation• Access to MDR-TB care is limited in the public sector• Care is often sought from untrained providers who do not follow international standards• Second-line drugs not internationally quality assured and purchase unregulated in many countries (exceptions – Brazil and South Africa)• Weak infection control practices in care facilities• Shortages of trained staff• Infectious patients remain in community UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  10. 10. Challenge 5 – Access to diagnosis• Laboratories capable of drug susceptibility testing are few• Classical methods of diagnosis take 3 months or more• New, rapid molecular tests expensive and rolling out, but slowly UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012
  11. 11. There are , sosolutionsto all thesechallenges UNITAID Technical Briefing, 65th World Health Assembly, 21st May 2012

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