Diagnosed Cases of Multidrug — Diagnosed cases of multidrug-resistant tuberculosis (MDR-TB) have nearly doubled globally but treatment in countries like South Africa's is not keeping up, leaving patients to die and communities at risk, according to a new World Health Organisation report.
WHO released its annual Global TB Report on 23 October 2013. According to the report, about 20 percent of the 94,000 MDR-TB cases diagnosed last year globally went untreated. Without treatment, MDR-TB patients face death and the likelihood of spreading MDR-TB within their communities.
In South Africa, which diagnosed about 15,400 MDR-TB cases last year, MDR-TB treatment gaps are widening as access to testing increases.
According to the WHO, South Africa is the first high TB burden country to roll out the rapid TB and MDR-TB test, the GeneXpert. However, the country experienced shortages of the testing cartridges in the first half of 2013.
GeneXpert maker Cepheid has since planned to increase its production capacity and buffer stocks of cartridges to avoid future stock outs.
MDR-TB is resistant to both the most commonly used anti-TB drugs, rifampicin and isoniazid.
Rising rates of not only new MDR-TB but also TB are just two reasons the country is likely to reach several of the United Nations' Millennium Development Goals (MDGs) including targets to reduce new TB cases and deaths. The country is also unlikely to meet other international targets to increase numbers of successfully treated MDR-TB patients.
Comprised of about 20 pills a day and painful injections, MDR-TB treatment is difficult to adhere to and takes about two years to complete. Even if patients adhere to the difficult treatment, half are likely to die from MDR-TB.
Earlier this year, the Medicines Control Council approved limited access for up to 200 patients to a new drug-resistant TB treatment, bedaquiline. Although approved for use in the United States as MDR-TB treatment, the drug is not yet registered for use as drug-resistant TB treatment in South Africa.
According to Doctors Without Borders' (DWB) Dr Vivian Cox, the data collected from these patients alongside that from clinical studies will be useful in advocating for the drug's future use at a time when better treatment options are needed.
"We need a breakthrough in treatment options to transform drug resistant TB treatment from an agonizing, toxic and prohibitively expensive two-year ordeal, to a shorter, more tolerable, more effective and more affordable treatment course," said DWB Access Campaign TB Advisor, Dr. Grania Brigden.
Meanwhile, one of the few drugs available to treat MDR-TB in South Africa, linezolid, remains out of reach for many patients. Currently, the drug costs up to R20,000 per month of treatment due to patent protection. While its patent expires in 2014, a patent on a crystallised form of the drug may block generics from entering the South African market until 2022, according to DWB.
An Indian generic currently costs about R750 per month.
To further prevent TB deaths and meet international targets, the WHO says South Africa will have to improve the quality of TB treatment and continue to target at-risk populations such as miners and people living with HIV. The country will also need to continue to decentralise TB services.
While most people carry TB, only about ten percent will ever develop active TB disease. With comprised immune systems, people living with HIV are more than 30 times more likely to develop active TB than those who are HIV-negative. TB remains a leading killer of HIV-positive people globally.
South Africa is however set to meet MDGs regarding increased TB case finding and cure rates. The report also notes that South Africa has made strides in addressing HIV and TB co-infection. About 84 percent of all South African TB patients know their HIV status and more than half of all HIV/TB co-infected patients are on antiretrovirals (ARVs).
Research from South Africa's Aurum Institute has shown that ARVs, when taken together with TB treatment can halve this risk of death. According to the WHO's latest report, only 54 percent of HIV-positive TB patients are also on ARVs.
The report added that South Africa is currently planning a national TB prevalence survey that will help guide its fight against TB in the future.