Furthermore, the report notes that only 15 of the countries studied allow healthcare workers to start adults on treatment for drug-sensitive TB (DS-TB). And, while 19 of the surveyed nations initiate treatment from drug-resistant TB (DR-TB) at the district level, only 11 have implemented the policy nationally. Additionally, although hospitalization should be reserved for severe cases of DR-TB, according to published guidelines, 10 of the countries studied still recommend it for all patients.
The report also found that fixed-dose combination therapy for children with DS-TB is the standard of care in only 14 of the countries, and short-course therapy for DR-TB is only recommended in 13. In addition, preventive therapy for those with latent TB is only widely available in 9 of the countries studied.
Despite these policy failures, there were some positive findings of the report. In all, 25 of the countries allow access to unregistered TB medicines as part of compassionate care programs, a vital element as only 21 of those countries have procedures in place for the accelerated registration of anti-TB drugs. Interestingly, none of the countries included in the analysis list all the anti-TB medicines recommended by WHO for the treatment of DR-TB in their respective national Essential Medicines Lists.
According to Lynch, all countries worldwide need to improve access to available treatments for TB and bolster existing research and development efforts to develop new ones, as MSF data suggests that, currently, only slightly more than half of those with multidrug-resistant TB benefit from available treatments because of issues with access to the medications. In addition, all countries should be making Xpert MTB/RIF testing available universally to “clos[e] the diagnostic gap.”
“In recent years, countries have implemented new policies to tackle TB; however, there remains a gap between policy and practice and the most vulnerable continue to lose out,” according to Lynch. “We insist that all actors—governments and WHO—take care to include TB in any new efforts involving antimicrobial resistance. After all, according to experts, one quarter of the potential 10 million annual antimicrobial resistance deaths by 2050 are projected to be caused by DR-TB.”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.
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