multi-drug resistant tuberculosis (MDR-TB)

 {Photo credit: WHO, Western Pacific Regional Office}Participants of the 10th National TB Programme Managers Meeting in the Western Pacific Region in Manila, Philippines.Photo credit: WHO, Western Pacific Regional Office

Tuberculosis (TB) has surpassed HIV and AIDS as the number one infectious killer worldwide, and in many countries, TB remains a major cause of death, sickness, and poverty. Major challenges to TB care and control include increases in drug-resistant TB (DR-TB) and reductions in donor funding.

It is crucial, therefore, that governments develop sustainable TB care and control delivery and financing mechanisms in the context of universal health coverage (UHC) programs.

Earlier this month I presented on this topic and MSH’s experience supporting TB program costing, economic analysis, and financing in Indonesia, at the 10th National TB Programme Managers Meeting in the Western Pacific Region in Manila, Philippines. With assistance from MSH under the US Agency for International Development (USAID) TB CARE I project, the Indonesian government has been a leader in South East Asia in terms of projecting financing needs, looking at cost-effective interventions, and working with the private health sector and national insurance scheme to expand coverage and ensure quality of care.

 {Photo credit: Brigid Boettler/MSH}Expert panelists discuss MDR-TB (from left): Joshua Michaud, Kaiser Family Foundation; Alexander Golubkov, USAID; Muluken Melese, MSH, Ethiopia; and Kenneth Mutesasira, MSH, Uganda.Photo credit: Brigid Boettler/MSH

“When we started our project in 2011, there was no system in place to identify multidrug-resistant tuberculosis (MDR-TB),” explained Muluken Melese, project director for the Help Ethiopia Address the Low Tuberculosis Performance (HEAL TB) project. However, since then, the five-year USAID-funded project, implemented by Management Sciences for Health (MSH), has expanded access to TB services to over half the population of Ethiopia and led a 15-fold increase in the number of MDR-TB patients on treatment.

 {Photo credit: Durmuş Şahin}(left to right) Dr. Raed Arafat, Chair of the Conference, Secretary of State, Ministry of Health of Romania; Dr. Martin van den Boom, TB Program Focal Officer, WHO Regional Office for Europe; Francis (Kofi) Aboagye-Nyame, Director, SIAPS Program; and Dr. Joel Keravec, Head of Operations, Global Drug Facility, Stop TB Partnership, at the First Conference on Pharmaceutical Management for TB and M/XDR-TB for the WHO European Region.Photo credit: Durmuş Şahin

The highest rate of multi-drug resistant (M) and extensively drug-resistant (XDR) cases of tuberculosis (TB) is found in the World Health Organization (WHO) European Region. The Consolidated Action Plan to Prevent and Combat M/XDR-TB in the WHO European Region specifies that, by the end of 2013, all member states assure provision of an interrupted supply of quality first- and second-line medicines for treatment of all TB and M/XDR-TB patients.

Safe and rational use of these medicines is also a challenge. To deal with these demanding challenges means an increased need to strengthen pharmaceutical management, especially in the areas of second-line TB medicines management, new TB medicines, and novel treatment regimens.

Mildred Fernando shares her story of surviving XDR-TB at a symposium in Japan.

I never thought that being sick with tuberculosis (TB) for a decade would lead me to this purpose: being an advocate to fight and eliminate this disease--not just in my country, the Philippines, but all over the world.

I was recently invited by RESULTS Japan to represent TB patients' perspectives in the call for continuous funding from the Japanese government to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The advocacy activities, led by Results Japan, were in support to the Global Fund Fourth Replenishment which aims to secure financing for the years 2014-2016.

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

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.

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