The ‘Out of Step’ report is based on a survey conducted by MSF in eight countries: Brazil, India, Kenya, Myanmar, the Russian Federation, South Africa, Uzbekistan and Zimbabwe.
The report reveals five deadly gaps in the TB response that, according to MSF, 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 medications
- dire funding shortfalls.
MSF has been involved in 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 programmes to treat MDR-TB opened in 1999, and the organisation is now one of the largest NGO treatment providers for drug-resistant TB. In 2013, the organisation treated 32,000 patients with TB in 24 countries, including 1,950 patients with DR-TB.
Information for the report was collected from March to July 2014 on 30 key indicators related to TB care. The report combines information from published sources with MSF experience, and makes recommendations that could help significantly improve the response to and management of DR-TB in particular.
The report habituates drug-resistant (DR-TB) as a global health emergency. According to MSF, Multi-drug resistant TB (MDR-TB) and extensively-drug resistant TB (XDR-TB) cases have risen: some countries now report that up to 35% of new TB patients have MDR-TB, with indications pointing to a significant increase in the spread of the disease from person to person.
TB and palliative care
Dr Emmanuel Luyirika, Executive Director of the African Palliative Care Association (APCA), said: “I would like to welcome the MSF report on TB which highlights the challenge that TB poses to the global population. The credentials of MSF regarding TB care and treatment are unequalled and so we have to take the report seriously.
In my own experience as a physician in Uganda, when faced with an HIV patient with multi-drug resistant TB, I could only turn to MSF to provide the required medications for MDR-TB which were not available in the national TB programme.
This highlights the challenges that palliative care providers are facing and will continue to face as regards TB in their practice, especially in Africa where the TB burden is high.”
He continued, saying: “TB does not only pose a threat to the general population. The healthcare workers who are involved in patient care are at serious risk of acquiring and developing TB.
Palliative care programmes therefore ought to integrate TB knowledge and awareness as well as direct TB care and treatment or patient referral into their approaches in order to ensure contribution to TB control.”
A pivotal time
According to the authors of the report, now is a pivotal time in the fight against TB with new tools emerging that offer the potential to strengthen and accelerate the global response.
This includes two new medications that were introduced more than a year ago, and repurposed medications that show promise in DR-TB treatment. Yet, few patients have benefitted from improved treatments to date.
The report comes at a crucial time, as the International Union Against Tuberculosis and Lung Disease is holding its 45th World Conference on Lung Health in Barcelona this week.
Among the topics discussed is a symposium titled “Community Engagement and Relief of Suffering in Palliative Care,” led by World Hospice and Palliative Care Alliance (WHPCA) Senior Fellow, Dr Stephen R Connor, along with 4 other faculty discussing palliative care for drug resistant TB in South Africa, Latvia, Russia, and Viet Nam.
Dr Connor said: “The global TB community has accepted the need to include palliative care in the continuum of care for those with drug resistant TB and those where treatment for cure has failed.”
WHPCA was also involved in publishing a ‘Declaration on Palliative Care and MDR/XDR-TB‘ that can be downloaded from their website.
How quickly and effectively new and improved tools are leveraged to impact the overall TB response is largely dependent upon three factors: effective policies at the national level; full implementation of current WHO guidelines; and access to new medications and diagnostics.
An assessment of where countries are in their response to the DR-TB epidemic is necessary to ensure that the benefits of the latest tools and policies are maximised and new advances in TB care can be implemented quickly.
MSF have said that drug-resistant forms of the disease will continue to spread unabated unless a stronger and more concerted effort to scale up DR-TB services, in step with the implementation of optimal tools, guidelines and policies, is made at the country level.
Adoption by WHO member states of the ambitious 20 year global TB targets has set the stage for a large-scale international response.
The report concludes that: “Now countries and global health actors at every level must step up their commitment and actions to ensure major strides are taken in the fight against TB, and in particular to curb the global DR-TB crisis.
Industry must also respond accordingly to the gravitas of the situation and ensure new and promising tools, notably improved treatments, are made available and affordable at the earliest opportunity.”