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Drug resistant TB a global 'public health crisis'
Multi-drug resistant tuberculosis (MDR-TB) has been dubbed a major ‘public health crisis’ in the new Global Tuberculosis Report 2013, released this week by the World Health Organisation (WHO). Whilst much of the world is largely on track to meet many of the targets set in Millennium Development Goal (MDG) 6, there remain significant barriers to combatting this entirely preventable and treatable disease. The report details five priority areas to combat the global tuberculosis (TB) epidemic, including reaching undiagnosed TB cases; addressing MDR-TB; responding to TB/ HIV co-infection; and addressing research and funding gaps.
Globally, rates of new TB infections and TB deaths are on track to meeting the 2015 targets. New TB infections have decreased annually across all WHO regions, but the rate of decline is considered slow at 2 percent; deaths relating to TB have also declined by 45 percent since 1990. TB prevalence is falling, however the rate of decline means that it is not expected to meet the target of a 50 percent reduction by 2015. Regionally, Africa and Europe are not on target to reach mortality and prevalence targets, and alarmingly the diagnosis and treatment of MDR-TB is ‘far off-track’, according to the report.
The problem of MDR-TB is worrying many working in public health around the world, as it is difficult and more expensive to treat. Dr Mario Raviglione of MSF stated, “It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care. We have patients diagnosed but not enough drugs supplied or trained people to treat them.” To reach the target, action is needed to fill the gap between diagnosis and treatment of MDR-TB, making drugs more cost effective and accessing reliable supply chains.
According to the report there are 3 million people each year who are left undiagnosed with TB, either because of poor access to healthcare systems, or because they are undetected when in care. In order to combat this, the report says that a greater integration of private and public sector surveillance and reporting is needed, so that all TB cases are met with a high quality of care. Even more crucial, as many of these undiagnosed people have MDR-TB; in 2012 alone, less than 25% of MDR-TB cases were diagnosed.
Tackling the co-epidemics of TB and HIV is also a concern. Whilst it is recommended that all people with TB who are also and living with HIV should be on antiretroviral therapy, treatment coverage is still largely inadequate. The TB and HIV epidemics are closely linked - as TB is the leading cause of death for people living with HIV.
Finally, there are calls for increased funding and innovative research to be channelled towards combatting the TB epidemic. The report estimates a $2 billion annual funding gap for a full response, however this does not include money towards new technologies, such as diagnostics and treatment options. If these five priority actions are implemented fully, progress towards ending TB can be achieved.