P. Koshy , jacob.k@livemint.com
Drug misuse leading to resistant strain of TB
Proportion of improper dosage strengths in India was twice the average of the 10 nations surveyedJacob
A proliferation of tuberculosis drugs and a marked deviation from nationally mandated treatment plans may be a key cause of the increasing incidence of a highly resistant strain of tuberculosis in India, according to a study published in PLoS One, the peer-reviewed journal of the Public Library of Sciences.
“..At least a third of all private sector dosages of first-line TB drugs fall outside of national and international treatment recommendations. Any resulting drug misuse could be responsible for many treatment failures and for escalating the emergence of multidrug-resistant TB (MDR-TB), which is further worsening the TB epidemic.,” the researchers said in a press statement accompanying their publication.
The primary aim of the study was to ascertain the size of the private-sector drug supply market in 10 key developing countries which account for about 60% of the world’s tuberculosis patients.
The researchers found that India’s private TB drug market extended treatment to more than two million cases—more than all of the nine countries combined—and the proportion of improper dosage strengths in the country was twice the average of the 10 countries surveyed in the study.
For every 100 drugs required in the proper dosage to treat TB, there were 117 available—an oversupply that authors claim could play a role in fostering drug resistance. The researchers also found in a study of 100 physicians that nearly 80 different dosages and treatment plans were prescribed; internationally, there are only about 14 prescribed treatment combinations
To be sure, the study doesn’t draw a correlation between the extent of private sector participation in the TB drug market and the number of tuberculosis cases. Nor does it comment on whether public sector supply of TB drugs by government agencies ensures better recovery. The authors, most of whom are based in the United States, couldn’t be immediately contacted for an explanation.
TB is one of the leading causes of morbidity and mortality worldwide and claims around 1.7 million lives annually. One in five of these victims are found in India, which also harbours the highest number of TB patients globally. According to WHO, there were 440,000 cases of multidrug-resistant TB in the world in 2008; and at least a third of the MDR-TB patients who were able to access MDR-TB treatment still died. Figures for India aren’t available.
One reason why TB continues to reign in many parts of the world is the old and inadequate treatment for the disease. There have been no new TB drugs for nearly 50 years and current regimens take between six and nine months — too long and complex. As a result, many patients do not complete their drug regimen, which leads to drug resistance, an emerging global health threat. The treatment for drug-resistant TB can take two years or longer, involve multiple drugs and injectables, and is much more expensive than the first-level of treatment.
The research, which involved analysing questionnaires filled out by physicians and scrutinizing drug-sale databases, was conducted by the TB Alliance—a non-profit— and IMS Health (a healthcare market research and consulting-services firm), and is the first detailed study of the private TB drug market across multiple high-burden countries.
The Bill and Melinda Gates Foundation as well as the governments of the United Kingdom and the Netherlands are among those that funded the study.
Nearly equal amounts of TB drugs are dispensed in the public and private sectors (enough to treat 67% vs. 66% of estimated incidence, respectively) according to the study and though the size of the private sector market for TB drugs varies between countries, it has been steady within most countries over the past five years.
The authors say the study emphasizes that greater efforts ought to be made to co-opt the private sector in battling tuberculosis. “The private sector is keeping alive the confusion that existed previously in the public sector,” said Dr William Wells, the study’s lead author and director of Market Access at the TB Alliance, in a statement. “With this new baseline understanding of the TB drug market, we can no longer ignore the private sector’s critical role in the access equation for TB treatment and in the task of protecting both current drugs and new regimens from the development of resistance.”
“Most countries covered in this study have public-private mix (PPM) programmes for TB care,” said Mario Raviglione, Director of the Stop TB Department at WHO. “Based on country experiences, these programmes have shown good results in optimizing TB management by private care providers. But the size of the response is not commensurate with the size of the challenge; there is enormous scope to expand these programmes urgently. Private providers following best practices should be supported through accreditation and access to free TB drugs from the public sector, while those not doing so should be regulated.”
V. N. Singh, a tuberculosis expert at the All India Institute of Medical Sciences said the results of the study weren’t surprising because of India’s extremely poor network of public health care. “It isn’t easy for all patients to immediately access public health centres. That’s true across ailments and diseases and not TB alone. That said a significant majority of TB drugs, over 60%, is still available only via government channels.”
http://www.livemint.com/2011/05/05222638/Drug-misuse-leading-to-resista.html?atype=tp
Drug misuse leading to resistant strain of TB
Proportion of improper dosage strengths in India was twice the average of the 10 nations surveyedJacob
A proliferation of tuberculosis drugs and a marked deviation from nationally mandated treatment plans may be a key cause of the increasing incidence of a highly resistant strain of tuberculosis in India, according to a study published in PLoS One, the peer-reviewed journal of the Public Library of Sciences.
“..At least a third of all private sector dosages of first-line TB drugs fall outside of national and international treatment recommendations. Any resulting drug misuse could be responsible for many treatment failures and for escalating the emergence of multidrug-resistant TB (MDR-TB), which is further worsening the TB epidemic.,” the researchers said in a press statement accompanying their publication.
The primary aim of the study was to ascertain the size of the private-sector drug supply market in 10 key developing countries which account for about 60% of the world’s tuberculosis patients.
The researchers found that India’s private TB drug market extended treatment to more than two million cases—more than all of the nine countries combined—and the proportion of improper dosage strengths in the country was twice the average of the 10 countries surveyed in the study.
For every 100 drugs required in the proper dosage to treat TB, there were 117 available—an oversupply that authors claim could play a role in fostering drug resistance. The researchers also found in a study of 100 physicians that nearly 80 different dosages and treatment plans were prescribed; internationally, there are only about 14 prescribed treatment combinations
To be sure, the study doesn’t draw a correlation between the extent of private sector participation in the TB drug market and the number of tuberculosis cases. Nor does it comment on whether public sector supply of TB drugs by government agencies ensures better recovery. The authors, most of whom are based in the United States, couldn’t be immediately contacted for an explanation.
TB is one of the leading causes of morbidity and mortality worldwide and claims around 1.7 million lives annually. One in five of these victims are found in India, which also harbours the highest number of TB patients globally. According to WHO, there were 440,000 cases of multidrug-resistant TB in the world in 2008; and at least a third of the MDR-TB patients who were able to access MDR-TB treatment still died. Figures for India aren’t available.
One reason why TB continues to reign in many parts of the world is the old and inadequate treatment for the disease. There have been no new TB drugs for nearly 50 years and current regimens take between six and nine months — too long and complex. As a result, many patients do not complete their drug regimen, which leads to drug resistance, an emerging global health threat. The treatment for drug-resistant TB can take two years or longer, involve multiple drugs and injectables, and is much more expensive than the first-level of treatment.
The research, which involved analysing questionnaires filled out by physicians and scrutinizing drug-sale databases, was conducted by the TB Alliance—a non-profit— and IMS Health (a healthcare market research and consulting-services firm), and is the first detailed study of the private TB drug market across multiple high-burden countries.
The Bill and Melinda Gates Foundation as well as the governments of the United Kingdom and the Netherlands are among those that funded the study.
Nearly equal amounts of TB drugs are dispensed in the public and private sectors (enough to treat 67% vs. 66% of estimated incidence, respectively) according to the study and though the size of the private sector market for TB drugs varies between countries, it has been steady within most countries over the past five years.
The authors say the study emphasizes that greater efforts ought to be made to co-opt the private sector in battling tuberculosis. “The private sector is keeping alive the confusion that existed previously in the public sector,” said Dr William Wells, the study’s lead author and director of Market Access at the TB Alliance, in a statement. “With this new baseline understanding of the TB drug market, we can no longer ignore the private sector’s critical role in the access equation for TB treatment and in the task of protecting both current drugs and new regimens from the development of resistance.”
“Most countries covered in this study have public-private mix (PPM) programmes for TB care,” said Mario Raviglione, Director of the Stop TB Department at WHO. “Based on country experiences, these programmes have shown good results in optimizing TB management by private care providers. But the size of the response is not commensurate with the size of the challenge; there is enormous scope to expand these programmes urgently. Private providers following best practices should be supported through accreditation and access to free TB drugs from the public sector, while those not doing so should be regulated.”
V. N. Singh, a tuberculosis expert at the All India Institute of Medical Sciences said the results of the study weren’t surprising because of India’s extremely poor network of public health care. “It isn’t easy for all patients to immediately access public health centres. That’s true across ailments and diseases and not TB alone. That said a significant majority of TB drugs, over 60%, is still available only via government channels.”
http://www.livemint.com/2011/05/05222638/Drug-misuse-leading-to-resista.html?atype=tp
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