Tuberculosis drug resistance a global threat // Drug Repurposing

Tuberculosis drug resistance a global threat

Background

Tuberculosis is a high-priority communicable disease in the WHO Africa Region. Latest available information (2010 Global TB Control Report), (1) indicates that the African Region has the highest TB incidence rates (Figure 1) and with only 12% of the world population contributed 30% of notified TB cases in 2009. Case notification rates have increased from 82 per 100 000 in 1990 to 170 per 100 000 in 2009. At the same time, 55% of TB patients tested in the same year were HIV-positive, making HIV infection the single most important risk factor for TB incidence in the Region. This trend needs to be reversed for the Region to meet the Millennium Development Goals (MDG) targets for TB control.

Recognizing the threat posed by the TB epidemic, the WHO Regional Committee for Africa at its 53rd session in 2003 adopted Resolution AFR/RC53/R6 calling for scaling up of interventions against HIV/AIDS, TB and malaria in all Member States. Subsequently, at its 55th session in Maputo, Mozambique, in 2005, the Regional Committee declared TB an emergency in the African Region2 calling upon Member States to implement urgent and extraordinary actions to quickly bring the epidemic under control.

Notwithstanding, subsequent to this resolution, the region has been experiencing an increasing magnitude of multi-drug resistant TB forms, and reported the first ever outbreak of extensively drug-resistant TB in 2006. While initially thought to be a rare occurrence, more and more countries in all subregions have since begun to identify and set up treatment programmes for M/XDR-TB control (Table 2). The need for accelerated action is vital.

This paper seeks to chronicle the emergence of drug-resistant TB forms in the Region and actions proposed for its urgent control.

Emergence of Drug-Resistant TB Forms in the Region

Situation Analysis

Since 2006, the Region has witnessed the increasing emergence of multidrug-resistant TB and extensively drug-resistant TB cases defined respectively as TB caused by organisms that are resistant to at least isoniazid and rifampicin, and MDR-TB organisms that are also resistant to any one of the fluoroquinolone family of anti-TB medicines and to at least one of four injectable second-line drugs (amikacin, capreomycin, kanamycin and viomycin). Between January 2004 and December 2011 (tentative data), a total of 53 798 MDR-TB cases were reported by 42 countries (Table 1). At the same time, 3231 XDR-TB cases were reported from 8 countries, (3) 84% and 96.8% of them respectively from South Africa alone.

While 42 countries have ever notified cases of MDR- and or XDR-TB, only 28 of these are known to have structured treatment programmes in place.(4) Even where treatment programmes exist, not all confirmed cases are receiving treatment mostly due to the unavailability of adequate supplies of second-line anti-TB medicines.

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