MDR-TB

 {Photo credit: Jones Dizon/SIAPS.}Training participants try out the Pharmacovigilance Monitoring System (PViMS), a web-based application to help clinicians, regulatory bodies, and implementing partners monitor medicine safety specifically in resource-limited countries.Photo credit: Jones Dizon/SIAPS.

The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.

There’s a new medicine that can help. Through a partnership with Janssen Therapeutics of Johnson & Johnson that began in 2015, USAID introduced a program to distribute a new medicine called bedaquiline that helps patients with MDR-TB in low-income countries including the Philippines. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, which Management Sciences for Health (MSH) leads, has been helping to roll out bedaquiline in low-income countries.

But with any new treatment, active pharmacovigilance (PV) is needed to help ensure both patient safety and drug effectiveness. This means being able to monitor patients to identify and evaluate adverse events, such as unexpected or serious side effects, to better understand possible risks and improve treatment protocols.

{Photo credit: Warren Zelman.}Photo credit: Warren Zelman.

Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.

In many places, her story would have a sad ending—TB is one of the top three leading causes of death for women 15 to 44 in low- and middle-income countries.

But Azmara went to the Muja Health Center—one of over 1,600 supported by USAID's Help Ethiopia Address Low TB Performance (HEAL TB) program, and where MSH has been training health workers to screen patients for multidrug-resistant TB (MDR-TB).

MDR-TB cannot be treated with the two most potent first line anti-TB drugs and infects 6,000 Ethiopians each year. To help curb the spread of the disease, health workers learn how to screen people in close contact with MDR-TB patients. All of Azmara’s family members were tested and both she and her three year old son Feseha were found to have MDR-TB.

Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).

On the eve of World Tuberculosis Day, Voice of America interviewed Dr. Stephen Macharia, the TB CARE I country director for South Sudan.

During the interview (transcript, PDF), Dr. Macharia discussed the TB epidemic in South Sudan, TB CARE I project achievements, and the way forward for improving funding for TB services and multi-drug resistant TB (MDR-TB) control in fragile states, like South Sudan.

TB CARE I is a USAID-funded project, led by KNCV TB Foundation with partners, including Management Sciences for Health.

Voice of America, the official external broadcast institution of the United States federal government, produces nearly 1,500 hours of news and programs each week for an estimated global audience of 123 million people.

{Photo credit: Katy Doyle / MSH.}Photo credit: Katy Doyle / MSH.

Stop TB in my lifetime.

This global call to action---the Stop TB Partnership's theme for March 24, World TB Day 2013---is as relevant now as it was over a hundred years ago.

Progress toward reducing the global burden of tuberculosis (TB) has been impressive in recent years: TB mortality has fallen by 41 percent since 1990.

Yet, TB remains one of the world’s leading causes of death, killing more than 1.4 million people per year, including 70,000 children. In 2011, 600,000 people died of TB in Africa alone---including many people with HIV.

Low detection rates, new strains of multidrug resistant TB (MDR-TB), high prevalence of HIV/TB co-infection, and risk of TB among diabetes patients---nearly 10 percent of TB cases are linked to diabetes, add to the challenge of TB control, especially among the poor and most vulnerable.

Voices of TB participants (from left): David Rochkind (moderator); Rachel Urduno (Mexico/Texas); Andre Gariseb (Namibia); Pham Thu Hoa (Vietnam); Francis Apina (Kenya); Rosalie and Faith Stephson (Philippines/Texas); Endalkachew Fekadu Demmisse (Ethiopia). {Photo credit: Claire Moodie/MSH.}Photo credit: Claire Moodie/MSH.

Cross-posted on TB-CARE I.

World TB Day, March 24th, was commemorated in many countries around the world last week to acknowledge the accomplishments made in the fight against tuberculosis (TB), and to call attention to the work that still needs to be done.

Voices of TB, a unique event organized by USAID, featured former TB patients speaking about their personal fight against TB. Survivors of TB from Ethiopia, Kenya, Namibia and Vietnam --- four TB CARE I-supported countries --- and from the United States, spoke at the event on March 22 in Washington, D.C.

Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

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