Drug-resistant tuberculosis in the WHO Western Pacific Region.

Tauhid Islam,Cornelia Hennig,Tom Hiatt,Nobuyuki Nishikiori

doi:10.5365/wpsar.2014.5.4.007

Tauhid Islam, Cornelia Hennig + Show 2 more

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https://doi.org/10.5365/wpsar.2014.5.4.007

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Abstract

To review the latest information about tuberculosis (TB) drug resistance and programmatic management of drug-resistant TB in the Western Pacific Region of the World Health Organization (WHO). We analysed routine data reported by countries to WHO from 2007 to 2013, focusing on data from the following: surveillance and surveys of drug resistance, management of drug-resistant TB and financing related to multidrug-resistant TB (MDR-TB) management. In the Western Pacific Region, 4% (95% confidence interval [CI]: 3-6) of new and 22% (95% CI: 18-26) of previously treated TB cases were estimated to have MDR-TB; this means that in 2013, there were an estimated 71,000 (95% CI: 47,000-94,000) MDR-TB cases among notified pulmonary TB cases in this Region. The coverage of drug susceptibility testing (DST) among new and previously treated TB cases was 3% and 20%, respectively. In 2013, 11,153 cases were notified--16% of the estimated MDR-TB cases. Among the notified cases, 6926 or 62% were enrolled in treatment. Among all enrolled MDR-TB cases, 34% had second-line DST and of these, 13% were resistant to fluoroquinolones (FQ) and/or second-line injectable agents. The 2011 cohort of MDR-TB showed a 52% treatment success. Over the last five years, case notification and enrolment have increased more than five times, but the gap between notification and enrolment widened. The increasing trend in detection and enrolment of MDR-TB cases demonstrates readiness to scale up programmatic management of drug-resistant TB at the country level. However, considerable challenges remain.

Highlights

In the Western Pacific Region, 4% (95% confidence interval [CI]: 3–6) of new and 22% of previously treated TB cases were estimated to have multidrug-resistant tuberculosis (MDR-TB); this means that in 2013, there were an estimated 71 000 MDR-TB cases among notified pulmonary TB cases in this Region
The increasing trend in detection and enrolment of MDR-TB cases demonstrates readiness to scale up programmatic management of drug-resistant TB at the country level
The Western Pacific Region of the World Health Organization (WHO) has made substantial progress and reached the TB-related Millennium Development Goals and associated international targets in advance of the 2015 goal year: TB prevalence and mortality are below half of 1990 levels, and case detection and treatment success remain high

Summary

Introduction

In the Western Pacific Region, 4% (95% confidence interval [CI]: 3–6) of new and 22% (95% CI: 18–26) of previously treated TB cases were estimated to have MDR-TB; this means that in 2013, there were an estimated 71 000 (95% CI: 47 000–94 000) MDR-TB cases among notified pulmonary TB cases in this Region. The coverage of drug susceptibility testing (DST) among new and previously treated TB cases was 3% and 20%, respectively. 6926 or 62% were enrolled in treatment. Among all enrolled MDR-TB cases, 34% had second-line DST and of these, 13% were resistant to fluoroquinolones (FQ) and/or second-line injectable agents. The 2011 cohort of MDR-TB showed a 52% treatment success. Over the last five years, case notification and enrolment have increased more than five times, but the gap between notification and enrolment widened

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Conclusion