March 22, 2013 India
People living with MDR-TB and their healthcare providers call for urgent action
New Delhi, 22 March 2013—If measures to tackle multidrug-resistant tuberculosis (MDR-TB) are not significantly stepped up, including addressing barriers that prevent both research into better drug combinations and treatment scale up, MDR-TB rates will continue to increase worldwide and a historic opportunity to improve abysmal cure rates will have been squandered, medical humanitarian organisation Médecins Sans Frontières (MSF) warned today.
Two new drugs effective against MDR-TB must be used to make treatment much shorter, more effective and less toxic. This demand is among others made by people living with the disease and MSF medical staff from around the world in a public manifesto launched this week.
Read the ‘Test me, treat me’ manifesto and see who signed it at: msfaccess.org/TBmanifesto
“We have been waiting for half a century for new drugs that are effective against tuberculosis”, said Joanna Ladomirska, Medical co-ordinator for MSF in India. “Having two new drugs on the point of being approved is a major opportunity to improve treatment for MDR-TB, and we can’t afford to waste it. India must play a major role in researching how to use the new drugs in regimens that are much shorter, less toxic, and more effective.”
MSF projects in India are seeing increasing numbers of people with MDR-TB, with drug resistance found not only among patients who have previously failed TB treatment but also in patients newly diagnosed with TB – a clear sign that MDR-TB is being transmitted in its own right.
Left untreated, the infectious disease is lethal. Even with appropriate diagnosis treatment today puts people through two years of excruciating side effects, including psychosis, deafness, numbness and constant nausea, with painful daily injections for up to eight months. Barely half of people get cured.
“People with MDR-TB often experience awful side effects from the drugs they are taking and quite often it is very challenging for us to motivate them to continue with treatment”, says Ms Ladomirska. “We need a much shorter, less toxic, and oral treatment urgently.”
After close to five decades of insufficient research and development into TB, two new drugs – bedaquiline and delamanid – have recently been or are about to be approved. Research is urgently needed to determine the best way to use these new drugs so that treatment can be made shorter and more effective, and rolled out to treat the growing number of people with MDR-TB. People on MDR-TB treatment and their caregivers from around the world outline these and other demands in the Test me, treat me manifesto, and urge others to join their call for urgent action.
“The medicines I’ve been taking leave my hands and legs swollen. I vomit after taking them. I’m taking so many medicines”, said Abino*, a 20 year-old woman who receives treatment for MDR – TB from MSF in Mon, Nagaland. “Last year I was very sick and frustrated. I couldn’t understand why I wasn’t getting cured even after being on DOTs treatment for six months and then repeating it for another four months. I was finally screened for multidrug-resistant TB and put on treatment at the hospital supported by MSF.”
Abino’s story of late diagnosis is not an isolated case in India. Many TB patients fail to find out they have drug-resistant forms of the disease; some die without being properly diagnosed.
India does not yet have enough prequalified laboratories to conduct the drug-sensitivity testing needed to scale up diagnosis of MDR-TB. Diagnosis in the private and public sector is often incomplete, leading to inappropriate treatment and spreading resistance. At MSF’s Mumbai clinic, there has been a clear trend over the last two years of patients arriving with increasingly drug-resistant forms of the disease. Scaling up the numbers of accredited labs for first and second-line drug-sensitivity testing is urgently needed to provide people with the appropriate TB treatment the first time, and to avoid amplification of resistance in India.
India, Russia and China account for nearly 60% of the global MDR-TB case burden. Yet in 2011, less than one in five of an estimated 630,000 people with MDR-TB had been able to get the treatment they needed. With two new drugs available, high burden countries like India must scale up efforts to diagnose and treat MDR-TB now, so that robust programmes are in place once the new drugs are introduced.
See MSF infographics on TB – length of treatment, side effects, access to treatment etc – at msfaccess.org/TBmanifesto
* Name changed to main the anonymity of the patient.
Drug-resistant forms of TB are a neglected global health crisis: the World Health Organization estimates there were 630,000 cases of MDR-TB in 2011. MSF started providing treatment to people with MDR-TB in 2001. In 2011, MSF provided treatment to 1,300 people with MDR-TB in 21 countries.
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