MDR TB and INDIA

“ There’s no hiding from the fact that treating people with drug-resistant TB is a long, difficult and complex process. But it can be done – people who get treatment are cured and can go on with their lives once more – but it needs a firm political and financial commitment.” Dr. Frauke Jochims, MSF, TB Medical Advisor

Governments are not meeting the challenge of providing treatment for the rising numbers of people infected with drug-resistant tuberculosis (DR-TB), which has infected around five million people over the past ten years. DR-TB – which occurs when the TB bacterium becomes resistant to anti-TB drugs – can be cured in the majority of cases, but many people go undiagnosed and untreated because of the difficulties involved in getting a correct diagnosis, and the expensive and complex treatment. In what many hope will prove to be a breakthrough development, a new diagnostic test has been rolled out this year – including by MSF in seven countries – that can drastically reduce the time it takes to diagnose if a person has DR-TB, from several weeks to under two hours. Although the test is very expensive and is not as simple a test as is ultimately needed, the fact that it’s now a lot easier to diagnose people should spur governments into putting many more on treatment. This, in turn, may help break the vicious circle with DR-TB drugs. With few people on treatment, low demand means drug companies don’t invest in expanding production. And without economies of scale and competition, drug prices remain high, with treatment costing on average US$ 4,500 per patient – several hundred times more than a $19 treatment course for standard TB. It’s not surprising the numbers on treatment have so far stayed low.

In fact, over the last ten years, less than 1% of people with DR-TB have had access to appropriate treatment and 1.5 million have died. MSF has doubled the numbers of patients on treatment over the last decade, but the recent funding cuts announced by the Global Fund to Fight AIDS, TB and Malaria, have cast a shadow of uncertainty over expanding treatment in many countries affected by the disease.