TUBERCULOSIS: KENYA: XDR-TB case raises questions

NAIROBI, 28 February 2012 (PlusNews) -
The Kenyan government's recent failure to adequately treat a patient with extensively drug-resistant tuberculosis (XDR-TB) has some civil society organizations questioning whether the country's TB programme is equipped to diagnose and treat such patients.
In October 2011, an HIV-positive Nairobi woman was diagnosed with XDR-TB while receiving her treatment at the Kenyatta National Hospital for multi-drug resistant TB (MDR-TB). Treatment was provided by the hospital; however, she was prescribed three additional medicines that she had to buy herself, to supplement the regimen.
According to Allan Maleche, coordinator of the Kenya Legal and Ethical Issues Network on HIV and AIDS, KELIN, following a public outcry over the handling of the patient's case, the government has stepped in to pay for all her medication. But Maleche warned that more still had to be done.
“The government needs to have a policy that outlines clearly how it will deal with cases of XDR-TB because at the moment that is missing. The government must also invest in the treatment and care of XDR-TB patients in Kenya," he told IRIN/PlusNews.
MDR-TB is resistant to the two most powerful anti-TB drugs, while XDR-TB is resistant to these and at least two others. XDR-TB patients, who pose the greatest public health risk, are also the most difficult to treat. It costs about US$35,700 to treat a single case of XDR-TB per year and the treatment normally runs between 24 and 36 months.
“We have so far received only three cases of XDR-TB. Two have since died and one is on treatment. But it is difficult to say the exact number of such cases out there because no study has been done to ascertain this," said Joseph Sitienei, director of the National Leprosy and TB Control Programme.
There more than 500 known cases of MDR-TB in Kenya, and only 230 of these are on treatment, but activists warn that more cases could be going undetected.
The resources that are available ... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available

Underfunding
The government admits the TB programme in Kenya has not been adequately funded despite the country’s big TB burden. Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
"The resources that are available... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available," Sitienei told IRIN/PlusNews.
“We are looking for resources to enhance our capacity to deal with cases of both MDR-TB and XDR-TB in order to buy medicines and we are currently in the process of setting up a state of the art isolation ward at Kenyatta National Hospital. But as of today, individual health facilities have some sort of isolation wards that can be used from time to time," he added.
Another major challenge is that TB patients either report late to health facilities for diagnosis or default on their treatment, increasing their chances of developing drug-resistant TB.
Sitenei admitted that TB surveillance had to be improved, as the screening of MDR-TB patients for XDR-TB is "lacking".
“The government will also be training health personnel to be able to adequately do the screening... at the moment, we don’t have the capacity to adequately do the screening."
TB is the biggest killer of people living with HIV. The Kenya National AIDS Strategic Plan 2009-2013 notes that despite the fact that 80 percent of TB facilities provide HIV testing, just about 27 percent of HIV-positive TB patients receive antiretroviral treatment.
“The government has a policy to integrate TB and HIV programmes, but a lot still needs to be done to realize success. Health workers must be continuously sensitized on the need for the integration of care and treatment of the two diseases,” said Nelson Otuoma, coordinator of a local lobby group, Network of People living with HIV/AIDS in Kenya.
http://www.plusnews.org/report.aspx?reportID=94977

TUBERCULOSIS: Lilly Provides Additional Funding to Infectious Disease Research Institute to Identify New Tuberculosis Therapies

 SEATTLE, Nov. 17, 2011 /PRNewswire/ -- Eli Lilly and Company (NYSE: LLY) today announced that it is providing more than $4 million in additional funding to the Infectious Disease Research Institute. The funding will allow IDRI to continue its early phase drug discovery efforts focused on identifying new and better therapies in the fight against tuberculosis, including multidrug-resistant strains known as MDR-TB. In addition, Lilly will provide more than $1 million in-kind for volunteer time from Lilly scientists and access to the company's drug discovery expertise, chemical libraries, and research tools. These additional commitments bring Lilly's total support of early stage TB drug discovery efforts through IDRI to more than $20 million – and Lilly's total funding of TB and MDR-TB efforts to more than $170 million.
IDRI is a member of the Lilly TB Drug Discovery Initiative, a not-for-profit public-private partnership focused on accelerating early stage drug discovery for potential new treatments for TB. TB and MDR-TB disproportionately affect people in countries with developing economies.
"While preventable and treatable, nearly 1.5 million people die from TB and MDR-TB every year," said John C. Lechleiter, Ph.D., Eli Lilly and Company chairman, president and chief executive officer. "Today's TB drugs are decades old and must be taken for extended periods of time, which present challenges for patients and health care providers. More effective medicines with fewer side effects are desperately needed."
Lechleiter will address the company's new funding commitment to IDRI on Friday morning during a speech at the Washington Biotechnology and Biomedical Association (WBBA) meeting in Bellevue. During his speech, Lechleiter also will address multiple other issues important to the biopharmaceutical industry, including public policies supporting an environment that stimulates medical innovation.
Lilly TB Drug Discovery Initiative
The Lilly TB Drug Discovery Initiative was created in 2007 to accelerate early stage drug discovery by bringing together specialists from around the world for the systematic exploration of vast, private molecular libraries in search of new TB treatments.
Located within IDRI's base in Seattle, the Lilly TB Drug Discovery Initiative involves representatives of government agencies, philanthropic organizations, pharmaceutical companies, universities, and other research institutions. Its most important goal is filling the pipeline with future TB drugs.
Lilly provided $15 million to launch and support the effort for a five-year period. Included in Lilly's initial funding was $9 million in-kind – including fully equipped high-throughput screening and chemistry laboratories, research tools, and scientific and technical expertise – plus $6 million in cash to seed the organization. In addition to this initial funding, Lilly provided access to a library of compounds – which has now grown to more than 800,000 compounds.
Today's announcement of an additional $4.2 million in funding will allow IDRI to further its early phase drug discovery efforts focused on TB and MDR-TB through 2016.
Steven Reed, president, chief scientific officer and founder of IDRI said, "We are excited that Lilly is extending its support of our TB drug discovery program. It's a real vote of confidence in the quality of our scientists' work and the productivity of our collaborations."
Lilly's Evolving Role in the Fight against TB
In 1996, the nonprofit organization Partners in Health began pioneering work that demonstrated cure rates of more than 80 percent could be achieved for patients with MDR-TB using several drugs, including two Lilly antibiotics that the company had planned to stop manufacturing.
Lilly began offering the two medicines at steep discounts to countries facing MDR-TB outbreaks, increased its own production capacity and began freely transferring its manufacturing technology to local manufacturers in countries hit hardest by the disease.
This work officially evolved into The Lilly MDR-TB Partnership in 2003, becoming one of Lilly's signature corporate responsibility programs. Lilly originally committed $70 million to launch the partnership, elevate MDR-TB on the global health agenda, and transfer the company's technology. In 2007, Lilly expanded the duration and scope for the MDR-TB partnership by committing an additional $50 million to the collaboration to complete the technology transfer and strengthen awareness, prevention, and care for patients who suffer from MDR-TB. In October 2011, Lilly announced it would commit an additional $30 million to The Lilly MDR-TB Partnership to provide training for healthcare workers and to improve supply and access to safe, effective, and quality-assured second-line drugs.
Recognizing that new treatment options were needed, the company also launched the Lilly TB Drug Discovery Initiative in 2007 to spur early drug discovery efforts. Including today's announcement, Lilly has now committed more than $170 million to the global fight against TB and MDR-TB.
"Our financial contribution is small compared to the billions of dollars needed to fight TB and MDR-TB," said Lechleiter. "We cannot solve this global challenge alone, but – given our unique experience and capabilities – we will continue to play an important role as a catalyst."

About TB and MDR-TB
TB is caused by airborne bacteria that can spread to any organ of the body, but most often is found in the lungs. Symptoms may include severe and prolonged coughing, fever, weight loss, chest pain, and night sweats. The World Health Organization (WHO) defines MDR-TB as resistance to at least two first line anti-TB medicines. This type of TB often develops in patients who do not complete treatment for regular TB or who have failed first-line treatment.

http://www.prnewswire.com/news-releases/lilly-provides-additional-funding-to-infectious-disease-research-institute-to-identify-new-tuberculosis-therapies-134028703.html

TUBERCULOSIS: MDR-TB remains a difficult diagnosis for children

LILLE, 8 November 2011 (PlusNews)

 Photo: Eva-Lotta Jansson/IRIN/IFRC

Diagnosing MDR-TB in children still difficult Years of treatment and mounds of pills are hard work for older patients with multidrug resistant tuberculosis (MDR-TB), but in children, treatment becomes a minefield for patients and doctors alike.
MDR-TB is resistant to the most powerful drugs used to treat active TB, rifampicin and isoniazid. With weaker immune systems, children who contract TB - most often from parents - progress to active disease in about a year. But just how many children are affected is not known as there is almost no research into children and MDR-TB - and very little useful guidance on how to treat them.
There are only eight studies published on MDR-TB treatment outcomes among children, says Nathan Ford, medical coordinator for Médecins Sans Frontières’ (MSF) Campaign for Essential Medicines. Much of what does exist comes from South Africa's Stellenbosch University, whose researchers work in Cape Town's Tygerberg Hospital. The hospital began collecting data on drug resistant (DR-TB) tuberculosis among children in 2003.
Simon Schaaf, a professor at Stellenbosch, presented the findings of the hospital's latest such survey at the International Lung Health Conference, held recently in Lille, France. Among about 330 children with DR-TB, about 7 percent had MDR-TB - a figure that has remained relatively steady since the hospital began conducting the surveys.
According to Schaaf, paediatric DR-TB cases are often a window on local TB epidemics. In 2010, the Western Cape confirmed 1,400 MDR-TB cases - the second highest in the country.
The study found very low uptake of isoniazid preventative TB therapy (IPT) among paediatric patients, despite a national IPT policy. About 70 percent of children who would have qualified for IPT were never prescribed the preventative medication, which uses one of the main drugs used to treat active TB, isoniazid. About 5 percent of these children subsequently died.
With a small number of studies indicating the scope of MDR-TB among children, high-level awareness of the problem is lacking, according to Carlos Perez Velez, who is leading a study on new diagnostic methods to improve TB case detection among children in his native Colombia as part of his work with the US-based National Jewish Health respiratory hospital.
"You go to a minister of health and you tell them there's a problem with TB in children and he'll ask you for the data,” Perez Velez told IRIN/PlusNews. "You'll say there's no data. He'll say if there's no data then why are you saying there's a problem. It's the chicken and egg paradigm."
Late diagnosis
Children who develop the disease in their spinal column are often diagnosed too late, sometimes leading to long-term neurological effects and spinal deformity. Treatment for MDR spinal TB requires a mix of surgery and a long course of drugs.
Marianne Gale, a doctor with MSF, described the realities of diagnosing and treating children with MDR-TB. In 2010, the MSF clinic in the Nairobi slum of Mathare diagnosed a mother with MDR-TB. Her 18-month-old daughter had TB symptoms and a chest X-ray suggested she also had active TB but getting a culture was impossible.
Samples of sputum from suspected DR-TB patients are used to grow bacteria cultures that are then tested for drug resistance - but these are difficult to obtain from children.
"We actually had the capacity to do sputum induction, which in many sites we're not able to do," Gale said. "There were many attempts that were traumatic to the child and perhaps more traumatic to the staff. We managed to get a sample that actually never [developed] on culture."
Given the difficulties of diagnosing children, about half of all children treated for DR-TB in MSF's projects in Swaziland and South Africa are unconfirmed, leaving clinicians to make tough calls to start young patients on long treatment.
Gauging the dosage
Without a culture, Gale said clinic staff reluctantly started the child on MDR-TB medication - a challenge in and of itself.
"This child was 18 months old but only weighed 7.5kg so calculating the dosages and adjusting them as the child grew was a nightmare," said Gale, adding that the MSF clinic - with an in-house pharmacist - was probably better able to do this than most clinics in similar settings. "Manipulating the formulations was challenging and also how to make those drugs acceptable for this young child."
Both mother and child were doing well on treatment after six months but family pressure led both to discontinue treatment. While the clinic learned that the mother had died, they were unable to trace the child.
Almost all MDR-TB drugs are designed for adults. "Almost all children will need these pills broken into bits, sometimes half, sometimes quarters; sometimes medication needs to be ground and most formulations don't dissolve completely in water," James Seddon, a researcher at the Desmond Tutu TB Centre in Cape Town, told IRIN/PlusNews. "Some [liquid forms] are available... but actually in most high TB burden areas they are not incredibly practical because they require refrigeration and also the glass of the bottle is very heavy for [transporting] to [clinics] that need large volumes."
Some children may also need to take vitamins or HIV medication and so may end up taking a large number of pills a day, Seddon added. Many do not taste good and may cause vomiting. MSF has lobbied the World Health Organization (WHO) to produce effective guidelines about the composition of new paediatric fixed-dose combination drugs that would reduce children’s pill burden and have been shown to improve adherence.
Meanwhile, existing guidelines need work. WHO, the UK and US have developed guidelines for paediatric MDR-TB treatment, but these are largely not evidence-based and, in some cases, may have been simply adapted from adult guidelines, noted Seddon.
http://www.plusnews.org/report.aspx?reportID=94164

TUBERCULOSIS: A new era for global tuberculosis control?

The Lancet, Volume 378, Issue 9785, Page 2, 2 July 2011
In this week's Lancet we publish a Seminar on tuberculosis, a disease that remains a major cause of death worldwide. Although tuberculosis is curable and preventable, long treatment durations, multidrug-resistant strains, a deadly association with HIV, and an inextricable link with poverty all mean that the disease presents an enormous challenge for countries to tackle. Although there has been commendable progress in case detection and aversion of deaths by treatment, in recent years the rates of decline in tuberculosis incidence have not been falling fast enough to meet global targets.

The central operation of global tuberculosis control is led by WHO's STOP TB department. It is aided by the STOP TB partnership, which is also housed at WHO, and consists of a coalition of different partners whose common aim is to rid the world of this disease. The partnership's core function is one of coordination, communication, and generation of the necessary advocacy around tuberculosis. Essentially, it is tasked to complement the role of WHO. At a time when global health governance is in transition, away from WHO as a monopoly and towards a more pluralistic leadership, many organisations are being plunged into a phase of change. As WHO prepares for reform, it is also adjusting to a new financially constrained environment. WHO's STOP TB department, like others, has to downsize and refocus its activities. With increasing demand for guidance, technical support, and capacity-building in countries, the STOP TB department and partnership will have to do more with less in the future.

As tuberculosis enters a new era, with promising new diagnostic approaches and drugs, WHO's role will be crucial. But there is also an opportunity to broaden the global response and engage with other partners more effectively in much the same way as the HIV/AIDS community has done successfully. A Lancet Series last year argued strongly that it was time to move away from the over medicalisation of tuberculosis and recognise its intersection with other sectors and populations—eg, women and children. If the next phase of the epidemic is to be truly different, so too must be the organisational response. A status quo in tuberculosis control is unacceptable.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61000-3/fulltext?rss=yes

TUBERCULOSIS: a disease of the poor

Kristin Palitza : 6.07.2011
The prices of medicines for DR-TB are rising around the world.

Access to treatment for drug-resistant tuberculosis (DR-TB, its acronym in English) remains compromised, especially in developing countries of the South, because very few pharmaceutical companies make quality drugs. In addition, the lack of competition has driven up the prices of drugs.

In the last decade, about five million people worldwide have developed the DR-TB. But a "shockingly low number" of patients (less than one percent) have access to appropriate treatment, according to Medecins Sans Frontieres (MSF).
About 1.5 million patients died in the past 10 years. The situation is particularly acute in poor countries with high numbers of HIV infections (human immunodeficiency virus, which causes AIDS), particularly where antiretroviral treatments are inadequate. South Africa is one of them.
One of the main barriers to treatment is the limited availability and high cost of quality medicines to treat DR-TB. For some drugs, there is only one manufacturer of assured quality or a single source for the necessary active ingredient.
"There is little investment in research and development of drugs against tuberculosis because it is a disease of the poor, and therefore a lucrative market doesn't exist for the pharmaceutical industry," said the office coordinator for MSF South Africa, Eric Goemaere.
 This has pushed up prices of most drugs for DR-TB. Treatment can cost a patient $9,000, according to MSF, almost 475 times more than the common treatment of tuberculosis.
Costs have increased further in recent years. "While drug prices usually fall with higher demand, in the case of drugs against drug resistant TB, they grow, some up to 600 or 900 percent. That is simply wrong," said Goemaere, who heads a project of treatment for HIV and tuberculosis in Khayelitsha, the third largest informal settlement in South Africa.
The exorbitant increase in prices is due to the lack of effective control mechanisms that no longer exist and subsidies don't exist to keep them low. It is also a reflection of insufficient competition in the market.
Only six products (for five different drugs for DR-TB) have been prequalified by the World Health Organization, and only four sources (for two different drugs) are recommended for purchase this year.
WHO responded to the growing need for drugs against drug resistant TB in 2000, creating the Green Light Committee, which reviews official health and non-governmental projects and the possibility they would allow access to medicines of proven quality at reduced prices.
Although the Committee is theoretically useful, the bureaucracy has prevented several treatment programs around the world from being of benefit.
In 2010, only 12,000 patients were enrolled in treatment programs approved by the Committee, against 440,000 new cases of the disease and 150,000 deaths, according to MSF. Only 13 percent of the estimated market of drugs for DR-TB is currently channeled through the Global Drug Facility of the WHO.
"WHO has responsibility for this disaster," Goemaere said.
Non-governmental organizations lobbied WHO for years until it created the Committee. But strict conditions and cumbersome administrative procedures prevent many health care providers from benefiting.
"The Committee provides few incentives because their quality guarantee endorsement is much more bureaucratic and centralized. The rules are self-limiting, making WHO into a doorman more than someone who provides support," Goemaere pointed out.
WHO's chief medical officer for TB in South Africa, Kalpesh Rahevar, recognized the Committee's administrative barriers, but said the agency had begun a reform process in early 2010.
"We're trying to simplify the request process," said Rahevar. "WHO also plans to extend its mandate to monitor TB programs worldwide, not just those that are involved with the Committee."
But until then, hundreds of organizations and health departments will have to keep on buying drugs to treat drug resistant TB from pharmaceutical companies that offer products of doubtful quality and high prices.
The Health Department of South Africa is one of them. Instead of requesting membership to the Committee, the ministry purchases drugs at fixed prices directly from South African subsidiaries of U.S. manufacturers, Sandoz Aventis and Sandoz.
According to the temporary Director of the department for treatment of tuberculosis, communications and social mobilization, Garvon Molefe, the ministry decided to buy medicines exclusively local, even if more expensive, in order to benefit the national economy.
"The reason why the Department doesn't continue the Committee's initiative is that after an alarming unemployment rate in South Africa, they do not want to waste the local pharmaceutical firms that give work to South Africans," he told IPS.
The Department currently spends $4,400 for treatment for each DR-TB patient. Goemaere said MSF, through the Committee, pays about 30 percent less for the same drugs, which means more patients can be treated for the same money.

Translated from the Spanish version by: Lisa Karpova
http://english.pravda.ru/health/06-07-2011/118403-Tuberculosis_disease_of_the_poor-0/

TUBERCULOSIS: Pakistan: Tuberculosis cases on the rise

Muhammad Qasim : July 08, 2011
The primary, secondary and tertiary healthcare facilities in this region of the country have been receiving significant influx of patients with tuberculosis and the number of patients with TB being registered at the allied hospitals is continuously on the rise.
Health experts say that the number of patients with TB all across the country is on the rise and the problem is getting worse with increase in the number of cases of drug-resistant TB.
“The situation is becoming alarming as Pakistan ranks 6th among countries having drug-resistant TB,” said medical specialist at Benazir Bhutto Hospital Dr. Muhammad Haroon while talking to ‘The News’ on Thursday.
He said that Pakistan has over 170,000 registered patients of drug resistant TB while the number of unregistered patients might be many more. The number of patients with drug resistant TB being registered at the allied hospitals here in the town is continuously on the rise, however, no attention has so far been paid to the problem by the concerned government authorities.
XDR-TB is resistant to routine anti-TB drugs as well as second line drugs. The mortality rate is 80 to 88 per cent after complications and recurrence is very common and almost invariably fatal, said Dr Haroon.
He said that XDR-TB is considered as more dangerous than bio-warfare organisms like anthrax and small pox as a single patient of it is enough to kill hundreds by coughing in crowded places like public transport vehicles, offices and schools.
Studies reveal that current default rate in Pakistani TB patients is 11%, which leads to Multi-drug resistant TB (MDR-TB) and in some cases extensively drug-resistant TB (XDR-TB), which is the most dangerous form of TB with no treatment.
According to estimates, over 1.6 million suffer from TB in Pakistan; more than 410,000 new cases add up to the country’s escalating TB burden every year with prevalence of 373 cases per 100,000 population and incidence of 231per 100,000 population and the number is constantly increasing due to lack of adequate precautionary measures.

It is important that left untreated, one person with active TB might infect 10 to 15 people during one year. The delay in diagnosis, unsupervised, inappropriate and inadequate drug regimens, poor follow-up and lack of social support programme for high risk populations are some of the reasons for not reaching the target
cure rates and emergence of drug resistant forms of tuberculosis.

TB is one of the oldest diseases caused by a rod-shaped bacteria also found in the mummies of Egypt showing its ancient origin. It can affect any part of the body including brain, bones, lungs, heart, eyes and skin, said Dr Haroon.
The occurrence of XDR-TB in Pakistan has increased from 1.5 per cent in 2006, to 4.5 per cent in 2009, said Dr Haroon adding urgent measures are required to avoid exponential rise in XDR-TB. He said that the problem should be taken as a regional issue.
Associate Professor of Medicine and renowned pulmonologist at Rawalpindi Medical College Dr Nadeem Iqbal Sheikh when contacted by ‘The News’ Thursday said that the number of cases of drug resistant TB is on the rise all across the country because of lack of drugs and anti-biotic policy.

Like other hospitals of the country, the allied hospitals in the town have no anti-biotic policy that is causing rise in drug resistant diseases including TB. “Lack of rational use of drugs particularly antibiotics and anti-TB drugs are making the situation more and more alarming with the passage of every day,” said Dr Sheikh.
He said that drugs for treatment of TB are free but most of the patients do not follow the ideal protocol and leave treatment incomplete that is a major reason behind spread of drug resistant TB.
http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=56545&Cat=6&dt=7/8/2011

TUBERCULOSIS: Progress on MDR-TB, but not enough

JOHANNESBURG, 24 March 2011 (PlusNews)

 Photo: Gary Hampton/World Lung Foundation
MDR-TB is resistant to first-line TB drugs

Gains have been made in stopping multidrug-resistant tuberculosis (MDR-TB), a largely undiagnosed killer, but not enough. By 2015 there will be two million new cases, says a new report by the World Health Organization (WHO).
MDR-TB is resistant to first-line TB drugs, such as isoniazid and rifampicin, while extensively drug-resistant TB (XDR-TB) is resistant to these drugs as well as at least half of the mostly commonly used second-line drugs.
In 2008, the latest year for which estimates are available, WHO put the number of MDR-TB cases at 440,000 globally, with 34 percent resulting in death.
In its new progress report, the organization charted gains made in the fight against drug-resistant TB, including increases in second-line drug availability, diagnostic capability, and national TB drug-resistance data.
Dr Ernesto Jaramillo, the WHO medical officer in charge of MDR-TB policy and author of the report, said the world was far from being on track to meet the 2015 deadline for universal access to diagnosis and treatment of resistant patients.
He stressed that MDR-TB was a complex issue, and cited a lack of funding, capacity and adequate staff in the 27 countries with a high MDR-TB burden.
WHO noted in its 127-page report that the Global Drug Facility, a WHO procurement mechanism, had improved access to drugs, and although the number of pharmaceutical companies supplying these drugs had tripled since 2008, it remains small.
National laboratory capabilities have also improved and all high- burdened countries can now conduct drug susceptibility tests to confirm MDR-TB at their larger reference laboratories, but point-of-care diagnostics are still scarce. WHO expects that by 2012, all high-burdened countries will have representative data on TB drug resistance to help guide their response.
In 2010, the Foundation for Innovative New Diagnostics (FIND) released the Xpert MTB/RIF TB point-of-care test, which detects TB and rifampicin resistance within two hours. The test is much more accurate than those previously available at district-level health centres, but at US$17,000 per unit the machine may prove too costly for widespread use in developing countries.
The report called for more funding for research into devices like this as well new treatments and vaccines. It also noted that a lack of such diagnostic tools may be partly why only about 10 percent of MDR-TB patients in high-burden countries are diagnosed, and only about 11 percent globally receive treatment.
DOTS - Directly Observed Treatment, in which patients are individually observed and supported to take TB medication daily - remains the cornerstone of TB and MDR-TB control, but Jaramillo said implementation was often hampered by poor health systems, which might mistakenly be using old TB thinking to treat a new drug-resistance threat.
“It’s like dealing with a new disease,” he told IRIN/PlusNews. “The only thing [MDR-TB] has in common with the old TB is the letters ‘T’ and ‘B’ - the drugs are new, the ways of monitoring patients are new, and the patients are more difficult to treat.”

Show me the money
Although countries have increased domestic funding for MDR-TB programmes, WHO and the Global Fund to Fight AIDS, TB and Malaria have warned that current allocations will be inadequate. WHO said an estimated $1 billion would be needed to fund the fight against MDR-TB by 2015 - about half current budget.
Contributions to the 2010 Global Fund replenishment fell short by an estimated $2billion, but it will still fund about 18 percent of the costs to control MDR-TB in 2011.
Some countries, like South Africa, the Russian Federation and Latvia, are likely to fund almost all of their MDR-TB response domestically, but the Fund may become the sole provider of second-line drugs and MDR-TB management in at least seven other high-burden countries.
“MDR-TB is a threat to all countries, as it is difficult and expensive to treat,” said Michel Kazatchkine, executive director of the Global Fund in a statement. “Unless we make an extraordinary effort to tackle this problem, our ability to finance and secure continued progress against TB in general will be threatened.”
Jaramillo noted that national economic decisions were often political ones, and urged civil society to keep the spotlight on TB as a top political priority in the worst affected countries.
http://www.plusnews.org/IndepthMain.aspx?InDepthID=90&ReportID=92273

TUBERCULOSIS: Ukraine: Review of the National Tuberculosis Programme

Edited by Pierpaolo de Colombani and Jaap Veen : 2011, xii + 69 pages : ISBN 978 92 890 0232 5
Free of charge

Ukraine has the second-highest burden of tuberculosis in the WHO European Region. In February 2010, the Minister of Health asked WHO to review the National Tuberculosis Programme, and make recommendations that could be used to help develop the Programme plan for 2012–2016. On 10–22 October, 13 international and 23 national experts reviewed documents, visited institutions and interviewed people in 8 oblasts and Kyiv.
The reviewers found a range of problems, from inconsistent implementation of the Stop TB Strategy between and within oblasts to tuberculosis services designed for health providers, not patients. Non-supportive legislation and an outdated health system, based on hospital care and with inflexible financing, limit current efforts to improve services. Action is urgently needed to stop the increase in multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) cases, the acceleration of HIV co-infection and high nosocomial TB transmission. The report of the review includes 14 recommendations made to the Government, the Ministry of Health and its partners.
http://www.euro.who.int/en/what-we-publish/abstracts/review-of-the-national-tuberculosis-programme-in-ukraine

TUBERCULOSIS: Australia: Fear clinic closure poses TB threat to Australia

Andree Withey and Charmaine Kane : Jun 10, 2011

A north Queensland university's head of medicine says the closure of tuberculosis (TB) clinics in the Torres Strait, off far north Queensland, will put the Australian population at risk.
Queensland Health is in the process of closing the clinics, which are used to treat Papua New Guinea nationals who cannot access treatment in that country.
Professor Ian Wronski, from James Cook University, says tuberculosis is a re-emerging disease and the closure of the clinics is likely to see it spread into Australia.
"Bit by bit it will re-establish in the Torres - it may well be there now," he said.
"Naturally people in PNG move in the Torres Strait and people in the Torres Strait move in the Cape and we'll see tuberculosis re-establish itself in Australia.
"About 25 per cent of multi-drug resistant TB in Australia actually comes from the PNG border.
"They're very hard to treat and there's one that's extremely difficult to treat.
"We're going to see multi-drug resistant forms grow in number and percentage."
State Health Minister Geoff Wilson says he is talking to the Federal Government about re-establishing funding for the clinics.
Queensland Liberal National Party (LNP) health spokesman Mark McArdle says the distance between PNG and the Torres Strait islands is smaller than people realise.
"With a dinghy and an outboard motor, you can cross from one to the other," he said.
"This could be a very serious situation and we need to get a hold of this very quickly, otherwise it could be a disaster down the track."
http://www.abc.net.au/news/stories/2011/06/10/3240493.htm

TUBERCULOSIS: Children and multidrug-resistant tuberculosis

Children and multidrug-resistant tuberculosis : Original Text: CE Jones, B Kampmann
Mercedes Becerra and colleagues (Jan 8, p 147) report high rates of tuberculosis in household contacts of patients with multidrug-resistant or extensively drug-resistant (MDR/XDR) tuberculosis. We welcome their recommendation that a diagnosis of MDR or XDR tuberculosis should prompt systematic surveillance of household contacts and investigations. However, they seem to have overlooked young children present in these households.
Children contribute substantially to the global burden of tuberculosis and young children are at increased risk of disease progression and poor outcome, particularly within the first 12 months after exposure.The prompt assessment of children in a household affected by tuberculosis is therefore essential. Few data exist to guide management of children in close contact with adults with drug-resistant disease. Becerra and colleagues' study provided an excellent opportunity to gather such data, but results on children younger than 5 years seem to have been omitted, and data from older children are not reported separately from the adult cohort. No conclusions relating to the risk of disease in children can therefore be drawn from this study.
We acknowledge that the diagnosis of paediatric tuberculosis can be challenging, which might have been the reason why paediatric issues were not addressed in this paper. Despite these difficulties, however, epidemiological data are urgently required to inform preventive strategies for this vulnerable group.Failure to report paediatric data represents a missed opportunity to inform such strategies. Future household contact studies should include children of all ages and report paediatric data in addition to adults.
The Lancet, Volume 377, Issue 9775, Pages 1404 - 1405, 23 April 2011 http://image.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60570-9/fulltext

Tuberculosis Complex Drug Resistance Pattern and Identification of Species Causing Tuberculosis in the West and Centre Regions of Cameroon

Background:

Data on the levels of resistance of Mycobacterium tuberculosis complex (MTBC) strains to first line anti-tuberculosis drugs in Cameroon, and on the species of MTBC circulating in the country are obsolete. The picture about 10 years after the last studies, and 6 years after the re-organisation of the National Tuberculosis (TB) Control Programme (NTBCP) is not known.

Methods:
The study was conducted from February to July 2009 in the Centre and West regions of Cameroon. A total of 756 suspected patients were studied. MTBC species were detected by the standard Ziehl-Neelsen staining method. Bacterial susceptibility to the first line drugs [isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (SM)] were performed on cultures using the indirect proportion method. MTBC species were identified by standard biochemical and culture methods.

Results:
Of the 756 suspected patients, 154 (20.37%) were positive by smear microscopy. Of these, 20.77% were HIV patients. The growth of Mycobacterium was observed with the sputa from 149 (96.75%) subjects. All the isolates were identified as either M. tuberculosis or M. africanum. Among these, 16 (10.73%) were resistant to at least one drug (13.3% for the West region and 8.1% for the Centre). The initial resistance rates were 7.35% for the Centre region and 11.29% for the West region, while the acquired resistance rates were 16.66% (1/6) for the Centre region and 23.07% (3/13) for the West. Within the two regions, the highest total resistance to one drug was obtained with INH and SM (2.68% each). Multidrug-resistance (MDR) was observed only in the West region at a rate of 6.67%. No resistance was recorded for EMB.

Conclusions:
M. tuberculosis and M. africanum remain the MTBC species causing pulmonary TB in the West and Centre regions of Cameroon. Following the re-organisation of the NTBCP, resistance to all first line anti-TB drugs has declined significantly (p < 0.05 for West; and p < 0.01 for Centre) in comparison to previous studies. However, the general rates of anti-TB drug resistance remain high in the country, underscoring the need for greater enforcement of control strategies.
http://www.mednewsafrica.com/2011/04/18/mycobacterium-tuberculosis-complex-drug-resistance-pattern-and-identification-of-species-causing-tuberculosis-in-the-west-and-centre-regions-of-cameroon/

TUBERCULOSIS: Challenges for tuberculosis (TB) control in the European Region

 (Photo: WHO)

The WHO European Region faces important challenges in its struggle against TB. The major constraints are:
the high rate of multidrug-resistant TB (MDR-TB), mostly in the countries of the former USSR;
the rapid growth of the HIV epidemic in eastern countries and central Asia and consequently the sharp increase in HIV-related TB;
the need to reform the health sector to include closer involvement of primary health care in TB control;
the still limited political and financial commitment to TB control;
lack of advocacy, communication and social mobilization.

In addition, prison inmates in the Region have a higher risk of developing active TB (including multidrug-resistant TB) than the general population, particularly in the former USSR. Poor infection control practices, delays in diagnosis, inadequate treatment, a high prevalence of HIV, overcrowding and poor nutrition all contribute to this risk.

Reversing the TB epidemic in the Region will require increased political and financial commitment from governments. Countries facing high TB burdens will have to increase their national expenditure on rational strategies to address the disease and its accompanying social conditions. Other countries in the Region and the European Union (EU) must raise awareness of the emergency in the Region and increase their own financial contribution to TB control
http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/tuberculosis/facts-and-figures/challenges-for-tuberculosis-tb-control-in-the-european-region

TUBERCULOSIS: The New Profile of Drug-Resistant Tuberculosis in Russia: A Global and Local Perspective – Summary of a Joint Workshop

Released: April 8, 2011
Type: Workshop Summary
Topic: Biomedical and Health Research
Activity: Forum on Drug Discovery, Development, and Translation
Board: Board on Health Sciences Policy
Note: Workshop Summaries contain the opinion of the presenters, but do NOT reflect the conclusions of the IOM. Learn more about the differences between Workshop Summaries and Consensus Reports.

Many tuberculosis (TB) experts and health authorities believe that the majority of the world’s drug-resistant TB cases are undiagnosed and untreated. These strains of the airborne disease are resistant to standard antibiotic treatment and present significant challenges in controlling its spread, diagnosing patients quickly and accurately, and using drugs to treat patients effectively. In Russia in recent decades, the rise of drug-resistant TB has been exacerbated by social, political, and economic upheavals. The size of the country presents additional problems in monitoring its occurrence and controlling its spread.
The IOM Forum on Drug Discovery, Development, and Translation, in conjunction with the Russian Academy of Medical Sciences, held a workshop May 26-27, 2010, in Moscow—the second in a series of international meetings designed to gather information from experts on the threat of drug-resistant TB and ways to combat it. Representatives from the Russian public health community shared their experiences in fighting drug-resistant TB, and participants discussed lessons learned, best practices, and new approaches that can be used worldwide to treat and prevent TB.
http://www.iom.edu/Reports/2011/New-Profile-of-Drug-Resistant-Tuberculosis-in-Russia.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=IOM+Report+Alert+-+REVISED+for+Outlook+07+-+TEST&utm_content=New%20Reports&utm_term=Non-profit

TUBERCULOSIS: Deadly Tuberculosis hits Uganda

8th April, 2011 : By Vicky Wandawa


WHILE it is already too bad that 100,000 Ugandans are contracting tuberculosis (TB) every year, much worse news has set in: A type of TB that is resistant to standard treatment has been spreading in the country and the treatment will cost sh11million per patient, enough to pay university fees for three years.
LIKE a common cold, TB starts with a cough, only that this cough cannot be treated by cough syrups and tablets bought over the counter.
“The cough usually lasts for more than two weeks and the patient produces sputum, sometimes laced with blood,” Henry Luzze, a medical officer at Mulago hospital’s TB unit explains. This could also be followed by excessive sweating at night and general body weakness.
Uganda is among the 22 countries in the world with the highest number of TB cases, with 100,000 new cases annually.
“These 22 countries carry about 80% of the world’s TB burden,” notes Dr. Joseph Kawuma, the executive secretary of Uganda Stop TB partnership.
Tuberculosis is caused by a species of bacteria known as Mycobacterium, which is spread mostly through the air, when an infected person coughs, spits, talks or even breathes around other people. There are other species spread through unboiled milk from infected cows.
Sadly, one cannot avoid the bacteria because they are everywhere. All that can be done to protect people from the virus is immunisation soon after birth. Even then, the immunization does not stop the TB germs from entering into your body. It only prevents the germs from making you sick.
According to the Ministry of Health, two thirds of all Ugandans have the TB germs in their lungs but they are not sick because they were immunised.
However, those with a weak body immunity are at risk of falling sick.
“In a lifetime, you have a 10% chance of contracting tuberculosis through inhalation but for one with HIV, the risk rises to 50%,” Luzze explains.
Meanwhile, Kawuma explains that 6 out of every 10 people with TB have HIV positive, and 3 out of 10 HIV patients have TB. The link between the two diseases is so strong that these days everyone with TB is advised to test for HIV and vise versa.
Besides HIV, Luzze explains that diabetes and malnourishment reduce one’s immunity, hence the risk of contracting tuberculosis is high. Poor ventilation and over exposure to the germs, also increases the chances of contracting TB.
Despite the risk, 10% of children born in Uganda do not receive the tuberculosis vaccine, BCG, which is supposed to be given free, immediately after birth.
Never the less, it is possible for a TB patient to heal completely. Luzze notes that TB requires a minimum of eight months treatment.
The first two months are referred to as the intensive phase of treatment. In Uganda, the treatment is free and can be accessed at all health centre IIIs, at the sub-county level.
However, even with the estimated 100,000 new cases annually, many miss out on the treatment. “There is evidence to show that we are treating barely half of these new cases,” Kawuma notes.
Many do not know they have TB, and do not go to hospital until it becomes worse. Even health workers sometimes take long to suspect that a patient has TB.
“Currently, there are numerous undetected cases of Tuberculosis in Uganda. Since the disease is airborne, wherever these patients breath, those around them are at a high risk of contracting the disease.” Kawuma says.
On average a TB patient can infect 10-15 other people in a year. The consolation is that once treatment has been started, patients cannot infect other people, if the medication is being taken as recommended.
An emerging challenge, however, is that the disease is becoming resistant to drugs. Doctors have noted a rise in the number of patients who do not heal when given the usual drugs.
In developed countries drug resistant TB (DR-TB) patients are being given drugs that are 15 times more expensive than the common ones. In Uganda, however, the drugs that treat DR-TB are not yet available.
The Ministry of Health has now created a coordination office to monitor the resistant strain of TB.
Dr. Samuel Kasozi, the coordinator for the DR-TB programme, says so far, 150 multi-drug resistant TB (MDR-TB) cases, have been detected from January 2008 to March 2011.
“The actual DR-TB burden in Uganda is not known but a survey to ascertain the burden is being carried out. MDR-TB occurs when the TB bacteria become resistant to the two most powerful first line anti-TB drugs,” Kasozi explains.
The emergence of Drug resistant TB is believed to be linked to poor adherence to prescribed TB treatment, social barriers such as stigma, discrimination, poverty, poor Direct Observation of Treatment (DOT) by treatment supporters and non compliance to the guidelines from prescribers partly due to drug stock-outs in some facilities.
The ordinary TB tests available at health centre IIIs cannot tell whether the infection is drug resistant or not. To detect drug resistance, sputum samples have to be tested from the national referral laboratory in Wandegeya, Kampala.
To do this, medics at the health centres seal a patients sputum in a box and send it to Kampala by post. The process is facilitated by the Centre for Disease Control.
http://www.newvision.co.ug/D/8/12/751525

TUBERCULOSIS: Some facts on drug-resistant "superbugs"

Reporting by Julie Steenhuysen in Chicago; Editing by Laura MacInnis: Apr 7 2011
LONDON (Reuters) - Some of the world's most powerful medicines are losing the war against drug-resistant strains of HIV, gonorrhea, tuberculosis and other microbes, global health experts said on Thursday.
"People assume that antibiotics will always be there to fight the worst infections, but antimicrobial resistance is robbing us of that certainty and new drug-resistant pathogens are emerging," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said on Thursday.
"It's not enough to hope that we'll have effective drugs to combat these infections. We must all act now to safeguard this important resource," Frieden said in a statement released to coincide with World Health Day.

Here are some facts from the CDC about antimicrobial resistance and what people can do to prevent it.
* Scope of the problem: Antimicrobial resistance occurs when germs change in a way that reduces or eliminates the effectiveness of drugs to treat them. This happens when antibiotics, antivirals, antifungals and other medications are used too liberally. About half of antimicrobial drugs -- antibiotics in particular -- are used unnecessarily or inappropriately prescribed in U.S. hospitals and in doctors' offices, the CDC says. The best approach to preserving those drugs is to use them only when needed.
* Cost: The United States spends more than $1.1 billion a year on unnecessary antibiotics for respiratory infections in adults. Antibiotic-resistant infections are responsible for $20 billion in excess healthcare costs and $35 billion in costs to society, such as lost wages, plus 8 million additional hospital days.
* HIV: Studies suggest 4 to 20 percent of newly diagnosed HIV patients have transmitted a drug-resistant infection. A 2007 study of HIV patients in the United States found one of every six newly diagnosed infections was drug-resistant. Doctors can help by testing for resistance before prescribing drugs, and patients can help by taking their drugs as prescribed and practicing safe sex.
* Malaria: Worldwide, there were an estimated 225 million malaria infections and 780,000 deaths in 2009. Most deaths were of children in Africa. Plasmodium falciparum, the most dangerous of the malaria parasites, has developed resistance in nearly all areas of the world where it is transmitted.
* Gonorrhea: More than 700,000 people in the United States become infected with gonorrhea each year, and the infection is showing increasing signs of antibiotic resistance. In 2009, 23.5 percent of gonorrhea strains showed resistance to penicillin, tetracycline, fluoroquinolones, or a combination of those antibiotics. Cephalosporins are the only class of antibiotics left, and preliminary data suggest resistant strains may be emerging. To fight this, the CDC is working with the National Institutes of Health to find other drugs to treat gonorrhea.
* Tuberculosis: About 1.3 percent of all U.S. TB cases reported in 2009 were multiple drug-resistant, or MDR, TB, and there has been one reported case of extensively drug-resistant (XDR) TB. With MDR or XDR-TB, the standard cocktail of antibiotics does not work and stronger medicines must be used, often for a longer time. Surgery may also be required to remove pockets of infection. To prevent the spread of drug-resistant TB, patients need to take all of their medications exactly as prescribed.

Source: U.S. Centers for Disease Control and Prevention
http://www.reuters.com/article/2011/04/07/us-antibiotics-factbox-idUSTRE7366WT20110407

TUBERCULOSIS: U.S. Cases of Drop, But Not Fast Enough

Patrick Corcoran: March 28, 2011
Federal authorities say reported cases of tuberculosis in the U.S. dropped to an all-time low in 2010.
As the Los Angeles Times reports, the Centers for Disease Control and Prevention say that the total fell 3.9 percent, to 11,181 cases.
However, the figures disappointed some experts. The 3.9 percent decline paled next to the 11.9 percent drop in 2009, and, more than 20 years ago, 2010 had been set as a target year for the eradication of TB in the U.S.
Four states accounted for 49 percent of the cases: Florida, New York, California and Texas. Among patients whose nationality was reported, 60.5 percent were foreign-born, with natives of Mexico accounting for the most cases in that category, followed by the Philippines, India and Vietnam.
The release of the U.S. numbers came as international efforts are intensifying to crack down on multi-drug-resistant TB, or MDR TB. The Stop TB Partnership, an international coalition, recently announced that without expanded efforts, the number of people inflected with MDR TB could swell to 2 million worldwide by 2015, causing hundreds of thousands of deaths.
In the U.S., there were 113 cases of MDR TB in 2009, the most recent year for which complete data are available
http://www.fairwarning.org/2011/03/u-s-cases-of-tuberculosis-drop-but-not-fast-enough-for-some/

TUBERCULOSIS: WHO warns of multi-drug resistant tuberculosis

April 2, 2011

The World Health Organization (WHO) warned that over 2 million people will become infected with multidrug-resistant tuberculosis (MDR TB) until 2015, exactly on the day that the World TB Day is celebrated on, March 24, recalling that, despite milestones achieved, further efforts are needed for all those affected by this disease so they can have access to treatment.
According to the director general of WHO, Dr. Margaret Chan, ""many countries have made progress"" in this field, but ""despite the recent growth efforts, the world needs to do much more for all MDR TB patients accessing the treatment they need.""
""We cannot allow drug-resistant tuberculosis to spread unchecked,"" she says. To live with untreated MDR-TB increases the risk of spreading TB strains resistant to drugs in the world.
Programs funded by the Global Foundation and subsequent WHO standard treatments are expected to diagnose and treat about 200,000 people of MDR-TB by 2015, a figure that is four times that of patients receiving treatment at present, only about 50,000 .
The Global Foundation will provide 84 percent of international funding for TB control in 2011. However, according to WHO, both international countries and organizations should increase their efforts against TB and progress in the fight against tuberculosis.
According to Professor Michel Kazatchkine, executive director of the Global Foundation, ""MDR-TB is a challenge for all countries because it is difficult and expensive to treat.""
""Unless there is not a special effort made to address this problem, our ability to finance and ensure progress against tuberculosis in general might be threatened,"" he warns.
For the special envoy for 'Stop TB' of the UN, Jorge Sampaio, ""it is time that countries with rapidly growing economies and a high burden of multidrug-resistant tuberculosis increase their commitment and funding for their programs against this disease.""
Since 2009, the 23 countries most affected by MDR-TB have almost doubled their burden of this disease. From 2002 to 2010, the Global Foundation has funded programs throughout the world that have provided treatment to about 7.7 million people, saving the lives of 4.1 million patients.
In 2009, WHO reported that 9.4 million people became infected with tuberculosis and 1.7 million died from this cause, among which 380,000 people with HIV-associated tuberculosis are included. In 2008 there were about 440,000 cases of MDR-TB and 150,000 deaths.
(Source: Latin Daily Financial News)
http://www.tehrantimes.com/index_View.asp?code=237853

TUBERCULOSIS: Australia: drug-resistant tuberculosis making comeback

 March 24, 2011
Tuberculosis looks intent to make a comeback following a big increase in cases of multi-drug resistant tuberculosis (MDR-TB) in Australia over the past few years, an Australian health care expert warned .
"The trend has been an increase in multi-drug resistant TB in Australia over the last 10 years, which is worrying," Dr Bernadette Saunders, from Sydney's Centenary Institute, said to mark World TB Day on Thursday.
Saunders has worked in the field of mycobacterial research for over 10 years. She has extensive experience investigating the immunology, pathology and genetics of tuberculosis disease.
"Many people thought tuberculosis would just disappear over time but, really, TB levels have been rising since the 1990s,"she said.
"It's a disease that we need to be aware of, certainly in terms of MDR-TB and, in the last few years, there has been what we call 'XDRs' which are extreme-drug resistant strains," she added.
There was a 30 percent rise in Australian cases of multi-drug resistant tuberculosis (MDR-TB) from 2007 to 2009, while in 2010 the nation recorded another rare case of even harder to kill XDR- TB.
About 1,200 TB cases diagnosed in Australia each year, and the proportion of MDR-TB infections seen in Australia has risen steadily - up from just eight cases in 2000 to 24 in 2007, and 31 in 2009.
About a quarter of all people infected with MDR-TB globally die from it - more than double the mortality rate of non-resistant TB.
Around the world, about eight to nine million new cases of TB infection are reported each year, with about 1.7 million deaths.
"It is a major, major health issue, across the globe," Saunders said.
"In some parts of the world levels of multi-drug resistance is very high and if we're not vigilant, and continue to work very hard, to keep drug resistance low and treat people who are multi- drug resistant, there is a strong potential for it to spread," she said.

Source: Xinhua
http://english.people.com.cn/90001/90782/90880/7330447.html

TUBERCULOSIS: WHO considers strategy to stop tuberculosis feeble

3/24/11
Luanda – The regional director of the World Health Organization (WHO) for Africa, Luís Gomes Sambo, affirmed that despite the fact that member states have adopted almost universally the strategy to stop tuberculosis, the implementation is feeble.
A message in the ambit of the World Tuberculosis Day (March 24) stated that 49 percent of the cases are annually detected, having 12 countries of the region, in 2008, achieved the internationally required goals recommended of a detection of at least 70 percent of new cases.
Gomes Sambo refers that WHO report on tuberculosis control indicates that in 2010 the African region (which represents only 12 percent of the world population) registered 23 percent of the total cases recorded worldwide.
WHO representative alerted that the cases connected to the increase of new challenges, such as co-infections TB/HIV and TB multi-resistance to medicine, complicates the control of the disease in the region, since about 35% of people with tuberculosis are HIV-positive.
Gomes Sambo said that there is the need for innovating actions to deal with the continuous challenges.
WHO will support countries to adopt new rapid test, which combines diagnosis in a unique test.
Gomes Sambo appealed to the national authorities to reinforce partnerships to stop tuberculosis in order to mobilize additional resources to control the disease, from government and private sectors.
http://www.portalangop.co.ao/motix/en_us/noticias/saude/2011/2/12/WHO-considers-strategy-stop-tuberculosis-feeble,83227e18-797e-4877-b766-45a071a4922b.html

TUBERCULOSIS: SOUTH AFRICA: Quick and easy TB diagnosis puts pressure on treatment

 Photo: Lee Middleton/IRIN: Simpler and quicker

KHAYELITSHA, 24 March 2011 (PlusNews) - A promising new diagnostic test for detecting drug-resistant tuberculosis (DR-TB) quickly and reliably is finally available, said a new report by Médecins Sans Frontières (MSF).
The possibility that the number of DR-TB cases might treble in South Africa, which has a high TB-burden, highlights the use of this new tool in relation to problems like the pricing and supply of DR-TB medication.
The "GeneXpert" machine - about the size of a milk crate - provides a fully automated nucleic acid amplification test (NAAT) that is effective in the early diagnosis of TB, multidrug-resistant TB (MDR-TB), and TB patients co-infected with HIV, which is more difficult to diagnose.
"I'm so proud to finally have this test," said Xoliswa Harmans, a former patient with extensively drug-resistant TB (XDR-TB) and HIV, whose diagnosis in 2008 took six weeks. "It was very difficult [waiting for my results]. I was very sick. I couldn't eat and was losing weight," said Harmans, who now works as a TB counsellor.
Unlike the previous "gold standard" test, which used a culture technique that could take six to eight weeks, this test - endorsed by the World health Organization (WHO) in December 2010 - provides results in about two hours and has a sensitivity rate of 90 percent.
Another advantage of the new test is its simplicity - it can be used by people who are not necessarily health
workers because sputum sample "cartridges" are simply inserted into the machine for diagnosis.
The Ubuntu Clinic in Khayelitsha, about 32km from Cape Town, is so far the only South African clinic to use the test. The township has one of the highest national and global rates for HIV and TB. In 2009, antenatal HIV prevalence was 30 percent, and the case notification rate for TB was at least 1,500 per 100,000 people annually - one of the highest levels of TB infection in the world.
"Because of the rise of HIV, TB has become more prevalent," said Dr Jennifer Hughes, DR-TB co-coordinator for MSF in Khayelitsha. "People with HIV are more susceptible to dying from TB, so if we can diagnose sooner we can get them on treatment sooner."
Patients diagnosed with DR-TB are immediately eligible for ARV treatment, whereas "normal" TB patients are eligible only if their CD4 count (which measures immune system strength) falls below 350.

An integrated, decentralized approach
Cikizwa Jonas, 56, started treatment at the Lizo Nobanda Clinic seven weeks ago. "I take 20 pills a day... After taking all the medication I get nausea and want to vomit."
The City of Cape Town, MSF, and the Western Cape provincial government started this "decentralized" pilot project in 2007 in response to the spread of drug-resistant TB. The Lizo Nobanda clinic is one of 10 in Khayelitsha that form the hub of an integrated yet decentralized community-based approach to TB-care and offers in-patient care for newly diagnosed DR-TB patients.
New patients often suffer the most severe side effects, and the clinic provides a comfortable, safe environment for patients to acclimatize to the treatment without being forced into a lengthy and often isolating hospital stay.

Fast Fact
Treating a drug-resistant TB patient for 24 months can cost up to US$9,000 - 470 times more than the $19 per patient it costs to cure standard TB
Previously, the long wait for diagnosis and poor tracking of those patients weeks later, followed by an automatic six-month stay in hospital, meant that thousands of DR-TB patients remained undiagnosed, or were diagnosed but had no access to treatment while they continued spreading the disease to others.
The patient-centred approach uses local clinics and includes methods like infection control teams, who visit patients' homes to make alterations that reduce transmission.
"We can provide care at the community and primary care health level, increase case detection and increase the number of patients on DR-TB treatment, which reduces transmission in the community," said Hughes.
"The biggest challenge [to the decentralized method] has been contesting the notion that DR-TB patients needed to be in hospital," Dr Carol Cragg, a medical officer overseeing HIV in Western Cape told a press conference at which MSF reported the first results of the programme.
Among the key successes are improved case detection (up from 118 in
2006 to 231 in 2009) and initiation of treatment (over 80 percent of patients diagnosed in 2009 and 2010 started treatment). The median time from detection to treatment initiation fell from 71 days in 2007 to 33 days in 2010.

Better drugs
Despite the improvements brought by the decentralized approach, and the rapid diagnosis available with the new test, providing treatment is still one of the chief problems.
DR-TB treatment requires standard antibiotics, many of which have severe side effects ranging from constant nausea to deafness, and must be taken as complex daily regimen of numerous pills for up to two years.
Shortages and high prices hound the DR-TB drugs, and the increased case load from using the new test will almost certainly exacerbate these problems. Studies indicate that a full roll-out of the new test could result in a three-fold increase in new DR-TB cases, and a doubling of the number of HIV-associated TB cases.
"If we find the [expected] numbers we'll have to treat them, and that will be very difficult," said Dr Gilles van Cutsem, medical coordinator at MSF in South Africa. Treating one DR-TB patient for 24 months can cost up to US$9,000, which is 470 times more than the $19 per patient it costs to cure standard, drug-sensitive TB.
"Patients have been stuck in a vicious circle - not enough people are diagnosed, and drug supply problems, along with high prices, stand in the way of putting more people on treatment," said Dr Tido von Schoen-Angerer, Executive Director of MSF’s Campaign for Access to Essential Medicines.
"The low demand for DR-TB drugs has made the market unattractive for producers, which is reinforcing supply and price problems," he noted.
TB is a curable disease that kills nearly 1.3 million people each year worldwide, and is the main cause of death in people living with HIV/AIDS in Africa. Of the 9.4 million new tuberculosis cases reported globally each year, 440,000 are multidrug resistant.
http://www.plusnews.org/report.aspx?reportID=92279