MDR-TB: a fight we cannot afford to lose! Alexander Golubkov, MD, MPH Senior TB Technical Advisor.

MDR-TB: a fight we cannot afford to lose!

Alexander Golubkov, MD, MPHSenior TB Technical Advisor

Global burden of TB in 2012

• 8.6 million incident cases of TB

• 1.3 million people died from the disease– 940,000 deaths among

people who were HIV-negative– 320,000 among people who

were HIV-positive– 170,000 death from MDR-TB

• 410,000 women died from TB (250,000 among HIV-negative women and 160,000 among HIV-positive women, an estimated numbers).

• 74,000 TB deaths among HIV-negative children

2

What is MDR-TB?

• Multi-drug resistant tuberculosis (MDR-TB) is a form of TB, when Mycobacteria is resistant to main anti-TB drugs:– Isoniazid and Rifampicin

• MDR-TB is treated with at least 4 medications, but usually 5-7 drugs

• Duration of MDR-TB is between 18 – 24 months

• Patient is getting injections for 6-8 months and oral meds daily, under the direct observation

• $10,000 – is a minimum cost for 1 case of MDR-TB patient– It’s about $250 to treat

sensitive TB 3

A MDR/XDR-TB patient in the Philippines receives trea

A MDR TB patient in the Philippines receives treatment

A MDR TB patient in the Philippines receives treatment

Percentage of new TB cases with MDR-TB

4Data: WHO Global TB report 2013

Percentage of previously treated TB cases with MDR-TB

5Data: WHO Global TB report 2013

Trends in MDR-TB estimation and notification

2006 2007 2008 2009 2010 2011 20120

50000

100000

150000

200000

250000

300000

350000

250000

250000

290000310000

300000

23,35329,778

30,00046,897

54,982

59,549

83,715

# esti-mated MDR-TB among notified

# noti-fied MDR-TB cases

6

Trends in MDR-TB estimation and notification

2006 2007 2008 2009 2010 2011 20120

50000

100000

150000

200000

250000

300000

350000

250000

250000

290000310000

300000

23,35329,778

30,00046,897

54,982

59,549

83,715

# esti-mated MDR-TB among notified

# noti-fied MDR-TB cases

25

0,4

51

21

6,2

85

7

Do we know how

many prevalent

MDR-TB cases in

the world?

Gaps in MDR-TB detection

2006 2007 2008 2009 2010 2011 20120

100000

200000

300000

400000

500000

600000

700000 650000630000

630000

250000

250000

290000310000

300000

23,35329,77830,00046,897

54,98259,54983,715

# es-ti-mated preva-lence# esti-mated MDR-TB among notified

# noti-fied MDR-TB cases

57

0,4

51

54

6,2

85

8

Gaps in DR-TB detection

2007 2011 2012Proportion of DST coverage among new cases

2.0% 4.0%5.1%

(3.9% in HBC)

Proportion of DST coverage among previously treated cases

4.7% 6.0%8.7%

(7.7% in HBC)

Prevalence of MDR-TB among new cases

3.1% 3.7% 3.6%

Prevalence of MDR-TB among retreatment cases

19.0% 20.0% 20.2%

9

WHO target is 20%

WHO target is

100%

Why are we behind?

• Countries need to have strong labs to diagnose MDR-TB; however GeneXpert is helping is to screen patients;

• Countries need to have facilities, staff and drugs to enroll patients on treatment;

• Programs need to keep patients adherent to a very long and unpleasant treatment…;

10Photos: William Wells

Treatment outcomes for patients diagnosed with MDR-TB. 2007–2010 cohorts.

11Data: WHO Global TB report 2013

Treatment outcomes for patients diagnosed with MDR-TB. 2007–2010 cohorts. By Regions

12Data: WHO Global TB report 2013

Monitoring time trends in % of MDR in new TB cases

Data

: W

HO

rep

ort

What is USAID doing to control MDR-TB?

• USAID has a target to support diagnosis and treatment of 57,200 MDR-TB cases/year

• USAID provides technical assistance to high burden countries to develop National Response Plans

• USAID helps national TB Programs to detect TB cases through laboratory support and GeneXpert procurement

• USAID supports country programs to improve quality of care provided

• USAID helps counties to leverage donor funds for TB and MDR-TB through assistance and collaboration

14

What should the international community do to stop MDR-TB epidemic?

• Have bold and inspiring VISION to eliminate TB and MDR-TB

• Focus on achieving results through partnership and collaboration

• Be accountable for progress made and resources used

• Include children, women and vulnerable populations in every TB program

• Build sustainable systems and promote countries ownership

• Be ambitious! 15

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