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Drug-Resistant TB
Minsk has extremely high levels of drug-resistant TB, a study in Belarus reveals

Minsk has extremely high levels of drug-resistant TB, a study in Belarus reveals

Resistance to anti-tuberculosis (TB) medicines is a major public health threat in most countries of the former Soviet Union. As no representative and quality-assured information on the magnitude of this problem existed in Belarus, a survey was conducted in the city of Minsk, the capital of Belarus. Between November 2009 and December 2010, 156 consecutively diagnosed new and 68 previously treated culture-positive TB patients residing in Minsk were enrolled in the survey. The study has revealed extremely high levels of drug-resistant TB in the city of Minsk. Multidrug-resistant (MDR)-TB was found in 35.3% (95% CI 27.7–42.8) of new patients and 76.5% (95% CI 66.1–86.8) of those previously treated. Overall, nearly one in two patients enrolled had MDR-TB. Extensively drug-resistant TB was reported in 15 of the 107 MDR-TB patients (14.0%, 95% CI 7.3–20.7). Patients <35 yrs of age have shown a two times higher odds ratio of multidrug-resistant TB than those aged >35 yrs. The findings of this survey in Minsk city are alarming and represent the highest proportions of MDR-TB ever recorded in the world. This study greatly contributes to the understanding of the burden of drug-resistant TB in urban areas of Belarus. The article can be read here: More…

Marina's story - fighting drug resistant TB in 3 different countries

Marina’s story – fighting drug resistant TB in 3 different countries

Marina is a Romanian citizen who was studying law at the University of Manchester in the UK when she was diagnosed with multidrug-resistant TB (MDR-TB). Marina was studying abroad in Lyon, France in summer 2012 when she developed a cough that would not go away. Her symptoms led her down a long road of doctors and tests as various French doctors struggled to identify a disease many believe no longer exists in Europe. One doctor even diagnosed Marina with hay fever and gave her medicines to ease hay fever symptoms. Despite multiple doctor visits, Marina’s symptoms failed to subside. Marina began to suspect her condition could be related to her lungs – possibly TB – after researching her symptoms online. Marina found a clinic that offered TB tests and had a lung x-ray done. The x-ray established there was something seriously wrong with her lungs, and she was referred for a CT scan. The CT scan confirmed there was a problem with her lungs but couldn’t determine what it was specifically, so Marina was referred for a bronchoscopy – a procedure in which a doctor interested a tube attached to a camera through Marina’s nose and down her airways to examine More…

Drug resistant tuberculosis a cross border threat: EU must act now!

Drug resistant tuberculosis a cross border threat: EU must act now!

  The TB Europe Coalition released a call to action urging the European Union to take immediate action against drug resistant tuberculosis, which is a serious cross-border health threat. With an estimated 74,000 cases of multi-drug resistant TB (MDR-TB) in 2012, the European region carries nearly a quarter of the global burden of drug-resistant cases and hosts 15 of the 27 high MDR-TB burden countries in the world, five of them being EU Member states. Many governments in the region often do not have the resources or the political will to adequately fight TB and are often dependent on external support to finance their TB programmes. However, the largest international donor for TB programmes, the Global Fund to Fight AIDS, TB and Malaria, is phasing out its support to the region, leaving an important financial vacuum. If European countries do not immediately step up their response we will be faced with an increased risk of MDR-TB spreading throughout the region on an even greater scale. Particularly concerning are the increasing rates of drug resistance among new TB cases and the low treatment success rates of the region: some of the most worrying in the world. According to a recent study, TB costs the More…

Tuberculosis: 'We are watching a ticking timebomb'

Tuberculosis: ‘We are watching a ticking timebomb’

Today saw the launch of the World Health Organisation (WHO) Global Tuberculosis Report 2013 whichmade it clear that there is not nearly enough being done to combat a disease that continues to place a terrible burden upon so many in all corners of the world. The report shows that TB deaths have only decreased from 1.4 million in 2011 to 1.3 million in 2012, a decrease of just 2%. Worryingly, these aren’t the most striking figures to emerge from the report. It shows that about three million people each year aren’t being diagnosed and getting the treatment they need. In addition, the report asserts that multidrug-resistant TB must be considered a public health crisis. The WHO estimate that 450,00 people fell ill with MDR-TB in 2012 alone. This strain is not only more costly to treat but treatment of the strains can burden individuals with often intolerable side-effects. That is if you’re lucky enough to actually receive the treatment. At least 16,000 MDR-TB cases reported to WHO in 2012 were not put on treatment and only 48% of those were enrolled on treatment were cured at the end of the two year period. Dr Lucica Ditiu, Executive Secretary of the Stop More…

Best practices in prevention control and care for drug-resistant TB

Best practices in prevention control and care for drug-resistant TB

The World Health Organisation have recently published a new compendium, ‘Best practices in prevention, control and care for drug-resistant tuberculosis: A resource for the continued implementation of the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant TB in the WHO European Region‘. The compendium recognises the progress that has been made in implementing the ‘Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively-Drug Resistant TB’ in the region but also makes clear that critical challenges still remain. As a result of these challenges, this new compendium has been released to improve the transfer of knowledge and experiences between countries in the European region and to help improve the health system approach. There are examples from nearly half the countries in the Region, providing invaluable information on MDR-TB control, including patient support, advocacy, communication and social mobilisation and also the needs of particular populations, that can be used to help shape how best to effectively combat and control MDR- and XDR-TB. We encourage you to read the compendium as a means of inspiring the work you do on TB in your country. 

Stop TB Partnership reduces price for drug-resistant TB treatment

Stop TB Partnership reduces price for drug-resistant TB treatment

The Stop TB Partnership’s Global Drug Facility (GDL) has been able to reduce the price of several second-line drugs for the treatment of multidrug resistant tuberculosis (MDR-TB). The GDL was able to reduce the price of drugs by up to 26% compared to 2011 prices, something which has resulted in a overall decrease in the cost of treatment. As the Stop TB Partnership suggests, this was done following a competitive tendering process among TB manufacturers and ongoing efforts by the GDF and its partners in consolidating order and broadening its supplier base for quality assured MDR-TB drugs. Given that MDR-TB can cost almost 100 times the amount compared to standard TB this 26% reduction undoubtedly represents an important step in the fight against TB and, particularly, in the fight against MDR-TB. This price reduction has been complemented by an increase in the delivery of MDR-TB drugs. While in 2011, 19,000 MDR-TB drugs were delivered this rose to 30,000 in 2012. Although, as stated by the Stop TB Partnership, despite this increase this figure represents just 13% of the 440,000 estimated new MDR-TB cases in 2011. Progress is clearly being made, but there is no doubt that more needs to be done collectively. More…

Study finds fake and poorly made drugs being used in the fight against tuberculosis

Study finds fake and poorly made drugs being used in the fight against tuberculosis

The fight against tuberculosis (TB) is being made more difficult as a result of the use of substandard and fake medication to treat the disease, a new study has revealed. In the biggest-ever study of its kind, researchers collected samples of two frontline anti-TB drugs (isoniazid and rifampicin) from pharmacies and local markets in 17 countries, including some in Europe. Worryingly, from these collected samples almost one in ten drugs failed to meet basic quality standards while around half of these had no active ingredient (the molecule that destroys the TB bacteria) whatsoever. The reasons for the existence of such poor quality drugs are wide-ranging. While it was discovered that some fake antibiotics were introduced into the markets by criminal enterprises , perhaps what is most shocking is that the vast majority actually came from legitimate manufacturers. These were just so poorly made they were ineffective or had corroded in transport. In order for TB treatment to be effective it is crucial that TB patients are able to access and are given the correct medication for the correct period of time. However, for many this involves a significant cost, both in travelling to supervised or accredited clinics and in purchasing More…

Belarus: the world's highest documented levels of MDR-TB

Belarus: the world’s highest documented levels of MDR-TB

In 2010, a survey conducted in Minsk, Belarus found that nearly one out of every two (47.8 percent) TB patients had multidrug-resistant TB (MDR-TB). These were the highest MDR-TB levels ever recorded. In response, the Belarusian Ministry of Health conducted a nationwide survey to better understand drug resistance across the country, as well as the risk factors that lead to MDR-TB. The national survey found similar levels as the initial Minsk survey did. Thirty-five percent of new TB cases and 45 percent of all TB patients in the study had MDR-TB. Of those with MDR-TB, 12 percent had extensively drug-resistant TB (XDR-TB), a form of resistance to second line drugs that develops on top of MDR-TB. The results confirm that the alarming levels of drug resistance first found in Minsk are not restricted to the capital city but are widespread across the country. The high level of new TB cases that have MDR-TB indicates that MDR-TB is easily being transmitted throughout the population. The authors cite poor management of TB patients, including poor lab facilities for TB diagnosis, a lack of standardised treatment, poor infection control within hospitals, failure in directly observing treatment, lack of patient support, drug stock-outs and More…

TB bacterium “is not resting”

TB bacterium “is not resting”

The weekly science journal Nature recently published an article called TB’s revenge: The world is starting to win the war against tuberculosis, but drug-resistant forms pose a new threat, which gives an excellent overview of where we are in the global fight against TB and, in particular, against drug-resistant TB: In the early 1980s, TB cases had dropped to such low rates that Western policy-makers frequently talked of eradication of the disease. Then came the HIV epidemic, which triggered a resurgence of TB in the late 1990s. But the latest report on TB from the World Health Organization (WHO), published in October, revealed signs of progress against normal — or drug-sensitive — cases of the bacterial disease. New infections have fallen and the mortality rate has dropped by 41% since 1990. But, the report warned, “drug-resistant TB threatens global TB control”. Some 3.7% of new cases and 20% of previously treated cases are MDR-TB. And whereas in 2000 the highest incidence of MDR-TB was 14%, in Estonia; in 2010 that figure had jumped to 35%, in Russia’s Arkhangelsk province. An estimated 9% of drug-resistant cases are XDR-TB, which has now been reported in 84 countries. It is a tale of More…

Europe’s fight with drug resistant TB – Estonia a model for success?

Europe’s fight with drug resistant TB – Estonia a model for success?

A recent article by the Wall Street Journal recently featured Estonia that by“turning the corner against drug-resistant TB offers one of the few bright spots globally as the ancient plague mutates into new and more deadly forms,” and suggested it could be a model for others. Levels of drug-resistant TB remain worryingly high in Eastern Europe, and the region continues to account for the highest proportion of multi-drug resistant TB (MDR-TB) cases in the world. In many of these countries, nearly a third of new TB cases are MDR-TB and more than half of previously treated cases have MDR-TB. Mario Raviglione, Director of the WHO’s Stop TB Department, has said, “Eastern Europe is in a disastrous situation with MDR-TB and it risks compromising anything you can do globally”. The Wall Street Journal article tells the story of Irina Nikolajeva who was diagnosed with a form of TB that was resistant to all but one of ten TB drugs: She was confined for four months in isolation, in a sparsely furnished room that resembled a prison cell and was painted a gloomy green. Yet it is the country’s unusually harsh regimen of confinement and intensive drug treatment that has helped dramatically More…

WHO report on tuberculosis highlights need for EU action

WHO report on tuberculosis highlights need for EU action

Last week the World Health Organisation (WHO) released their seventeenth global report on tuberculosis, providing a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control.  Positive steps have been made in tackling TB globally. Findings from the report indicate that progress has and is being made in a number of areas. It notes: access to TB care has expanded substantially since the mid-1990s; progress towards global targets for reductions in TB cases and deaths continues; there has been further progress in implementing collaborative TB/HIV activities; innovations in diagnostics are being implemented, and that the development of new drugs and new vaccines is also progressing. This progress is, of course, welcome news. However, TB remains a major global health problem, ranking only second to HIV/AIDS as the leading cause of death from an infectious disease. Latest estimates show that there were almost 9 million new TB cases in 2011 and 1.4 million TB deaths. As the report notes, this is despite the availability of treatment that will cure most cases of TB. Worryingly, progress in responding to multidrug-resistant TB (MDR-TB) remains slow. On a purely European outlook, this worry is exacerbated More…

TBEC works with Romanian civil society to develop advocacy plan for TB

TBEC works with Romanian civil society to develop advocacy plan for TB

Following the TB Europe Coalition’s visit to Romania last year, the Coalition found itself collaborating with Romanian Angel Appeal (RAA), a charity working on health issues and a principal recipient of the Global Fund to Fight AIDS, TB and Malaria. RAA organised an advocacy training for members of the Stop TB Partnership Romania and asked TBEC to help facilitate the two-day workshop. During the course of the workshop, it became clear that there is a lot of concern regarding the current TB situation in Romania, particularly around drug-resistant TB. Jonathan Stillo, a medical anthropologist studying TB in Romania who has recently joined TBEC, has described how Romania has one of the worst treatment success rates for multidrug-resistant TB (MDR-TB) in the world. Jon explained why: “This is due to a number of factors ranging from a severe lack of national funding and frequent drug stock-outs to stigmatization and a lack of knowledge about the disease and the severity of the situation, even among decision-makers.” Members of TBEC were able to see this for themselves during a visit to the drug-resistant TB ward at a hospital in Bucharest. There, they met two young girls in their early 20s, both appearing otherwise More…

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