Controlling multidrug-resistant tuberculosis and access to expensive drugs: a rational framework

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health Security

Background:

• Multidrug-resistant tuberculosis (MDR-TB) poses a significant global health threat.
• Effective strategies for MDR-TB control in resource-limited settings remain a challenge.
• The DOTS-Plus initiative explored programmatic MDR-TB treatment in low- and middle-income countries.

Purpose of the Study:

• To develop a framework for guiding MDR-TB management strategies in national TB programs.
• To assess the feasibility and cost-effectiveness of treating MDR-TB under program conditions.
• To inform resource allocation for MDR-TB control efforts.

Main Methods:

• Utilized data from the WHO/International Union Against Tuberculosis and Lung Disease surveillance project.
• Grouped countries based on TB treatment success rates and MDR-TB prevalence among new patients.
• Developed a matrix to guide decisions on implementing second-line drug treatment.

Main Results:

• Countries with treatment success rates below 70% require prioritization of DOTS implementation or improvement.
• Poorly functioning TB programs can exacerbate MDR-TB, irrespective of resource availability.
• Implementation challenges for MDR-TB treatment were found to be more significant than drug access.

Conclusions:

• A tiered approach is necessary, prioritizing DOTS and infection control, followed by judicious use of second-line drugs.
• The optimal timing for introducing second-line drug treatment depends on local context and resources.
• Increased human and financial resources are crucial for expanding DOTS globally and combating MDR-TB.