mdr-tb: a fight we cannot afford to lose! alexander golubkov, md, mph senior tb technical advisor
TRANSCRIPT
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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