Abstract
Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings.
Highlights
Multidrug-resistant tuberculosis (MDRTB), defined as TB resistant to at least isoniazid and rifampin, represents an obstacle to TB control, especially in areas where multidrugresistant tuberculosis (MDRTB) prevalence is high [1]
Four projects are integrated into the national TB program (NTP): Estonia, Latvia, Lima, and Tomsk
After successful piloting of MDRTB management within TB control programs, WHO and partners have reached the phase of expanding MDRTB control as a component of a comprehensive TB control program, which is described in the WHO guidelines for the treatment of TB [3], the new Stop TB Strategy [15], and in the new WHO guidelines for the programmatic management of drugresistant tuberculosis [26]
Summary
Multidrug-resistant tuberculosis (MDRTB), defined as TB resistant to at least isoniazid and rifampin, represents an obstacle to TB control, especially in areas where MDRTB prevalence is high [1]. Some of the requirements for GLC endorsement include a well-functioning DOTS program, long-term political commitment, rational case-finding strategies, diagnosis of MDRTB through quality-assured culture and drug susceptibility testing (DST), treatment strategies that use second-line drugs under proper management conditions, uninterrupted supply of quality-assured second-line drugs, and a recording and reporting system designed for MDRTB control programs that enables monitoring and evaluation of program performance and treatment outcome [11,13,14]. Some aspects in which MDRTB control programs may vary include whether all TB patients are tested with culture and DST or only patients with an increased risk for MDRTB, use of standardized or individualized second-line treatment regimen, and hospitalization of MDRTB patients or provision of treatment on an ambulatory basis This analysis of the first 5 GLC-endorsed MDRTB control programs provides, for the first time, results on management of MDRTB under DOTS-based program conditions in multiple resource-limited countries by using standardized treatment outcome definitions. The treatment success percentage was obtained by adding the percentage of cured patients to the percentage of patients who completed treatment
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