Thousands with tuberculosis not given treatment to stay alive, warns WHO

http://www.theguardian.com/global-development/2013/oct/23/tuberculosis-treatment-global-who
Sarah Boseley
Global failure to tackle multidrug-resistant tuberculosis costing lives, say experts, as three in four cases go undiagnosed

Approximately 16,000 people were diagnosed with multidrug-resistanttuberculosis in 2012 but were not given the treatment they needed to stay alive and prevent the spread of the disease, the World Health Organisation (WHO) has said.

While there has been some progress – with a drop in cases to 8.6m in 2012, from 8.7m in 2011, and in deaths from 1.4m in 2011 to 1.3m in 2012 – a report by the WHO says there are serious concerns about the estimated 3 million people with TB who are not receiving treatment because they live in remote rural areas, and about the spread of drug-resistant strains.

The director of its TB programme, Dr Mario Raviglione, warned on Wednesday of a public health crisis, while Médecins Sans Frontières (MSF), the international medical organisation, described the figures as shocking.

As the problem of MDR-TB grows, so do the waiting lists for the expensive and lengthy courses of treatment – it can take two years to cure somebody. Many countries are not getting high cure rates as a result.

"The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis," says Raviglione. "It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care. We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB."

An estimated 450,000 people contracted MDR-TB in 2012, the WHO says. The largest numbers were in China, India and Russia, but three in four estimated cases remained undiagnosed.

Dr Philipp Du Cros, infectious disease specialist at MSF, said: "These shocking figures are an indictment of the global failure to tackle drug-resistant tuberculosis head-on. People are paying for this failure with their lives … Unless we take urgent action, we will continue to see an increase in harder-to-treat drug-resistant strains of TB."

He called for more resources and better drugs to tackle the crisis. "To save lives, we urgently need governments, donors, and the Global Fund to properly resource the treatment of this deadly disease. We urgently need more research to make treatments for TB shorter, more effective and less damaging for patients. Patients with drug-resistant TB currently face an agonising two-year ordeal, taking large quantities of very harsh drugs with horrific side effects. Even then, it's only a flip of a coin chance that treatment will be successful."

The report calls for drug-resistant TB to be considered a public health crisis."In high MDR-TB burden countries, increased capacity to diagnose MDR-TB must be matched with supplies of quality drugs and scaled-up country capacity to deliver effective treatment and care," it says. "This will require high-level political will and leadership and more collaboration among partners, including drug regulatory authorities, donor and technical agencies, civil society and the pharmaceutical industry."

The 3 million missed cases must be reached, the WHO says. People who are HIV positive and have TB must be given antiretroviral drug treatment. The funding gap must be closed – an extra $2bn a year is needed on top of the $6bn made available for TB in 2013. "Progress remains fragile and could be reversed without adequate funding," the report warns.