Cape Town - The world may be losing the war against the rise of multidrug-resistant tuberculosis (TB).
The World Health Organisation’s (WHO) latest TB report says that almost a quarter of new TB cases are resistant to both of the most common treatments.
At the same time, researchers warn of a “looming epidemic” of TB and diabetes, with diabetics being up to three times more likely to develop active TB. Like HIV, diabetes suppresses a person’s immune system allowing latent TB to develop into an active infection.
The report, released on Wednesday, shows that 9.6 million people fell ill with TB in 2014 - almost seven percent increase in a year.
South Africa recorded the world’s sixth highest number of new TB cases in 2014, but the report notes that there has been a steady decrease in new TB cases since 2008. Previous research by the National Institute for Communicable Diseases has attributed the decline to the roll out of antiretroviral treatment, which has been shown to reduce an HIV-positive person’s risk of developing TB by about 45 percent. [45 percent links to http://www.aidsmap.com/Starting-ART-reduces-TB-risk-for-HIV-positive-patients-in-South-Africa/page/2989198/]
The report notes that only 40 percent MDR-TB patients worldwide were diagnosed. International humanitarian organisation Médecins Sans Frontières said the WHO’s report marked “yet another year of disheartening statistics” and warned that the world is losing the battle against drug-resistant TB.
“We’re losing ground in the battle to control drug-resistant forms of TB, and without considerable corrective action, the vast majority of people with MDR-TB won’t ever be diagnosed, put on treatment, or cured,” said Dr. Grania Brigden, interim medical director for MSF’s Access Campaign, which advocates for access to essential medicines globally. “Today, a person with MDR-TB has worse than a one in four chance of being properly diagnosed. “
In South Africa, MDR-TB comprises about two percent of all new TB cases and almost seven percent among people who have been re-diagnosed with TB.
“Diagnosis is just the first step: people who do access today’s standard treatment have only a one in two chance of being cured, while two newer drugs remain out of reach for the vast majority of people who need them,” added Brigden referring to international access to two new drugs delamanid and bedaquiline.
Bedaquiline was approved for use in South Africa in 2014, and is being rolled out nationwide. South Africans now account for half of all global patients started on the drug, said Dr Norbert Ndjeka, head of the Department of Health’s division on HIV, TB and drug-resistant TB.
As of June, a tender to introduce a second new drug-resistant TB drug, linezolid, was being drafted alongside a Medicine Control Council application to introduce a third new drug, delamanid.
Meanwhile, a report recently released at the World Lung Health conference in Barcelona called for dual screening for TB and diabetes to head off the “looming epidemic” of diabetes and TB.
“Diabetes is fuelling the spread of TB. Diabetes is also more difficult to manage in people who have TB. And a person sick with both diseases is likely to have complications that do not typically exist when either is present on its own,” according to the report produced by the International Union Against Tuberculosis and Lung Disease and the World Diabetes Foundation.
Some of the world’s worst affected countries for diabetes also have high TB rates, including Brazil, China, India, Indonesia and Russia.
However, on slightly better news, more than a decade after preventative TB treatment was introduced in South Africa, we are starting to chart gains.
Isoniazid preventative therapy (IPT) uses one of the TB treatment drugs, isoniazid, to suppress TB in people with HIV.
According to national guidelines, people living with HIV who have a positive reaction to TB skin tests should take IPT for three years. Those who are HIV positive and have a negative TB skin test should receive the daily medication for a year.
Dr. Liesl Page-Shipp, director of the TB programmes at the research organisation Aurum Institute, credits research on IPT’s benefits for the recent rise in uptake of the treatment.
“The greatest challenge is really doing what we need to do better – doing the basics,” she said. “We know what needs to be done and its’ making sure that the health system can support comprehensive care including IPT.”
She added that weakness in the health system lead to patients becoming lost in the system and that some studies have shown that as many as 18 percent of people tested for TB may never receive their results.
Health-e News
* See the report here