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Antimicrobial Resistance 2020

Why drug-resistant tuberculosis poses a major risk to global health security

Image: The Global Fund/ Atul Loke / Panos

Pooja, who lives near New Delhi, was suffering from drug resistant tuberculosis, a more aggressive strain of the disease that does not respond to first-line medication. After being diagnosed and treated by a community-based health program, Pooja was cured, and today leads a healthy and normal life. Community engagement is critical to ending TB. India has about 27 percent of the estimated global cases of TB, as well as a quarter of drug-resistant TB patients. 

Dr. Eliud Wandwalo

Head of TB, Global Fund to Fight Aids, Tuberculosis and Malaria

Headshot: The Global Fund/Vincent Becker

3 questions to Dr. Eliud Wandwalo, Head of TB at the Global Fund to Fight Aids, Tuberculosis and Malaria.

What is drug-resistant tuberculosis?

Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by tuberculosis (TB) bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates.

Multi-drug resistant TB (MDR-TB) is defined as TB bacteria that are resistant to two of the most important TB drugs, isoniazid (INH) and rifampicin (R).

Extensively drug-resistant tuberculosis (XDR-TB) is characterised when a person develops MDR-TB which is resistant to additional drugs including fluoroquinolones and injectables.

In 2019, an estimated 500,000 people developed DR-TB and 182,000 died globally.

What is the state of the fight against drug-resistant TB?

Overall, TB deaths have dropped by 25% since the Global Fund was founded in 2002. Yet in 2020, disruptions caused by the COVID-19 pandemic could lead to an additional 525,000 deaths from TB. In addition, the drug-resistant forms of the disease could rise, complicating an already dire situation.

In 2019, an estimated 500,000 people developed DR-TB and 182,000 died globally. Less than 60% of MDR-TB patients who initiate treatment are successfully treated, mostly due to high mortality and falling out of the treatment programs. Outcomes for individuals with XDR-TB are even worse, with approximately only one-third of patients successfully treated.

As treatment is long and hard, DR-TB patients often stop treatment before they should and when untreated or inadequately treated, they continue transmitting drug-resistant bacteria to others and have a higher risk of mortality.

How does the Global Fund contribute to fighting drug-resistant TB?

The Global Fund and its partners are supporting countries to transition to new all-oral regimens including new drugs (bedaquiline and delamanid) for the treatment of DR-TB. By the end of 2020, at least 125,000 people will have access to these regimens/medicines.

The Global Fund also invests in rapid molecular diagnostic machines, including GeneXpert tests which allow the screening of thousands of people with TB/DR-TB around the world quickly and efficiently, and which are now also used to test COVID-19. But technology alone is not enough. Community health workers are vital to the fight against TB – they provide assistance, raise awareness, fight stigma and improve access to TB services, treatment and care.

Treating DR-TB costs more and needs prolonged treatment duration. To step up the fight and achieve the global goal of ending TB as an epidemic by 2030, increased international funding and domestic resource allocation is urgently needed. The Global Fund provides 73% of all international financing for TB. Today, however, efforts to fight TB and DR-TB remain largely under-resourced.

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