Global availability of susceptibility testing for second-line anti-tuberculosis agents

Area of Science:

• Global Health
• Infectious Diseases
• Microbiology

Background:

• The development of new anti-tuberculosis (TB) agents necessitates corresponding treatment regimens to prevent resistance.
• Understanding pathogen susceptibility through antibiotic susceptibility testing (AST) is vital for global TB treatment strategies.

Purpose of the Study:

• To assess the global capacity and accessibility of antibiotic susceptibility testing (AST) for tuberculosis (TB).
• To identify barriers hindering widespread AST implementation.

Main Methods:

• A 12-question quantitative and qualitative survey was designed and distributed to key stakeholders in TB research and laboratory initiatives.
• Responses were collected from members of the Global Laboratory Initiative, Global Drug-resistant TB Initiative, and the International Union Against Tuberculosis and Lung Disease.

Main Results:

• 323 complete responses from 84 countries across all WHO Regions were analyzed.
• High AST capacity for fluoroquinolones and second-line injectables was observed globally.
• AST capacity for new and repurposed TB drugs is concentrated in European, American, and Western Pacific regions, with significant limitations in African and Eastern Mediterranean regions.
• Delayed AST turnaround times for second-line drugs were noted due to sample transportation challenges.
• Key barriers included inadequate specimen transportation, high costs, and a lack of specialized laboratory personnel and facilities.

Conclusions:

• Expanding global access to AST is critical to prevent increased drug resistance as new TB treatment options become available.
• There is an urgent and pressing need to enhance AST capacity and accessibility in parallel with the rollout of new TB therapeutics.