Challenges and opportunities in drug-resistant TB

Abstract

Tuberculosis (TB), the infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB), remains a significant global public health threat. TB is the worldwide leading cause of death from a bacterial disease and the second leading cause of death from an infectious disease after Human Immunodeficiency Virus (HIV) infections. Drug-Resistant TB (DRTB) is a growing concern around the world, but the magnitude of the disease burden is not well defined. A series of workshops (Program Chair, G.H. Cassell) was held by the Institute of Medicine (IOM) of the National Academy of Sciences in the United States of America in 2008 and, subsequently, in 2010–2013 in four of the highest burden countries (South Africa, Russia, India and China) to assess the reality of the challenge of DRTB and the gaps in knowledge required to address the threat. The issues discussed ranged from biology, epidemiology and surveillance to diagnosis, treatment and infection control, as well as the drug supply chain and the needs of vulnerable populations. Through these meetings, a new image has emerged that dictates dramatic and radical policy changes in the approach to TB if policy makers are to prevent TB from becoming once again an incurable disease. The findings were similar in each country and were equally concerning: (1) the magnitude of the problem of multi-drug and extensively-drug resistant TB is underestimated; (2) the number of patients receiving treatment is small and ineffective; (3) over 90% of patients are treated without drug susceptibility data; and (4) drug-resistant strains are spread from human to human far more commonly than previously appreciated. To date, programs have largely been based on an approach that emphasizes treatment of drug-sensitive cases. If these programs provided comprehensive care for both drug-sensitive and drug-resistant TB, this would be encompassing the entire TB epidemic and would be addressing the growing threat of the unchecked growth of resistant strains. In the current presentation, Dr. Gail Cassell, chair of the planning committee convening the IOM workshops, will present the themes, challenges and opportunities emerging from the IOM initiative and discuss potential global actions and next steps to combat DRTB.