national TB program

{Photo credit: Mark Tuschman.}Photo credit: Mark Tuschman.

This post originally appeared on the SIAPS website.

After decades of relying on old medicines, new drugs designed specifically for the treatment of tuberculosis (TB) are finally on the market. While these medicines represent a major advancement in the fight against TB, ensuring equitable access for patients is still an enormous challenge. At the 45th Union World Conference on Lung Health, the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, led by Management Sciences for Health (MSH), collaborated with the Stop TB Partnership Global Drug Facility (GDF) to host a full-day workshop addressing common hurdles to treatment access, as well as available solutions.

The SIAPS program focused on three common challenges in medicines availability: quantification, public-private mixes, and medicines safety.

 {Photo credit: © 2011 Arturo Sanabria, Courtesy of Photoshare}A health care provider dispenses TB drugs for Directly Observed Treatment (DOTS) at Tete's Urban Health Center, Mozambique.Photo credit: © 2011 Arturo Sanabria, Courtesy of Photoshare

Successfully combating the tuberculosis (TB) epidemic requires that national TB programs (NTPs) prevent new infections and ensure that current patients are cured. Although the treatment for drug-sensitive TB is very effective, curing the disease requires that patients adhere to a strict daily regimen of multiple pills for six to nine months. Adding to the challenge is the fact that treatment for drug-resistant TB is longer, more toxic, and less effective.

All medicines carry some risk of adverse events, and anti-TB medicines are no exception. In addition to threatening the health of patients, adverse events, if not well managed, may also result in individuals stopping their treatment early. Patients who prematurely discontinue treatment may remain sick, develop resistance to the medicines, and spread TB to others in their community.

To support NTPs and health professionals efforts to meet treatment goals and improve the safety of anti-TB medicines, the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program developed the first guide of its kind on minimizing risks associated with anti-TB medicines.

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

{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.

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