Streamlining and Collaborating on Diagnostic Financing and Drug Utilization Reviews Decreases Burden of Drug-Resistant TB

Streamlining and Collaborating on Diagnostic Financing and Drug Utilization Reviews Decreases Burden of Drug-Resistant TB

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.

Despite these substantial hurdles, a number of recent developments offer hope for decreasing the burden of DR-TB. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, led by Management Sciences for Health (MSH) with partners, is working with countries to develop streamlined approaches to financing diagnostics central to detecting DR-TB, while also developing guidelines to assist practitioners in monitoring the treatment of patients taking medicines for DR-TB.

Assessing financing for TB diagnostics

In the span of two hours, a new diagnostic called GeneXpert MTB/RIF can simultaneously diagnose TB and test for drug resistance---a process that previously took weeks or months. This new development has the potential to diagnose cases of DR-TB that otherwise would have been undetected, helping to ensure more patients with DR-TB have access to appropriate treatment.

To help countries plan for the rollout of new detection tools, SIAPS recently designed a collaborative approach for assessing the costs of scaling up new TB diagnostics and worked with the National Tuberculosis Programs (NTPs) in Rwanda and Uganda to assess their proposed roll-out plans for GeneXpert.

The comprehensive assessment, which included an estimation of future treatment costs resulting from heightened demand for DR-TB medicines, revealed significant gaps in the budgets allotted for the rollout of GeneXpert.

Through a collective effort, the countries had the opportunity to revise their planning to more comprehensively reflect the cost associated with scaling up diagnostics and subsequent treatment.

Conducting drug utilization reviews

SIAPS recently developed a guideline for countries to monitor the treatment of DR-TB by adapting an approach called a drug utilization review (DUR).  DURs are used to identify common problems in medicine management such as erroneous dosing, avoidable side effects, and incorrect medicine selection.

To support healthcare practitioners monitoring patients on anti-TB medicines, SIAPS produced Guidelines for Conducting Drug Resistant Tuberculosis Drug Utilization Reviews by compiling information about treatment from textbooks, medicine package inserts, and World Health Organization (WHO) Multidrug-Resistant TB guidelines to develop data collection forms and indicators.

The generic guidelines have been piloted in Kenya with the ultimate goal to develop a tool that NTPs can use as part of routine monitoring to ensure that TB programs are following the standards of care and that patients are carefully monitored for potential side effects. Through timely management of side effects, DURs help ensure that patients maintain better health and are able to complete their full course of treatment.

Building the capacity of NTPs while providing them with financial guidance and tools to use to better assess their medical and treatment needs is a crucial part of strengthening the overall health system. By improving the monitoring of TB programs especially with the use of a new diagnostic tool, NTPs are able to discover and treat MDR-TB cases before patients pass on the infection to others. At the same time, improved TB financial planning leads to better use of resources and planned procurements of medical products, such as GeneXpert MTB/RIF.

Emily Delmotte is a technical associate for TB at MSH.

Learn more about SIAPS improving pharmaceutical management for better health outcomes.

Editor’s note: This post is part of a " href="">World TB Day blog series on what works to stop TB. Join the conversation in the blog comments, and on Twitter with hashtags " href="" target="_blank"> and " href="" target="_blank">.