New guidelines and goals for treating MDR-TB announced

New guidelines for treating multi-drug resistant tuberculosis (MDR-TB) were announced at a gathering of TB experts in Atlanta on May 10. The strategy endorses the goal of increasing the number of MDR-TB patients receiving treatment 50-fold over the next decade. The guidelines and targets for treatment were issued by the World Health Organization (WHO) at a meeting with many collaborators on the guidelines, including Harvard Medical School, the U.S. Centers for Disease Control and Prevention (CDC), the Task Force for Child Survival, and Partners In Health.

The new guidelines, drawing on research from 46 projects in over 29 countries since 2000, provide specific instructions on how to expand and improve Directly Observed Therapy (DOTS) for MDR-TB patients, based on the best available evidence and the most effective drugs. The guidelines also seek to outline strategies for strengthening health systems, suggest ways of empowering people and communities dealing with TB, engage all care providers, and promote further research.

MDR-TB has been detected in every region of the world and the WHO estimates that more than 425,000 new MDR-TB cases emerge every year, with as many as one million active cases worldwide. The goal of the new guidelines and the Global Plan to Stop TB is to increase the number of MDR-TB patients receiving treatment from 16,000 today to a total of 800,000 treated patients worldwide by 2015.

"In the 1990s, many in the TB community were highly skeptical about the possibility of developing effective and affordable ways of treating MDR-TB in poor countries," said PIH co-founder Dr. Jim Yong Kim. "These guidelines have settled that argument. Treatment programs should now be scaled up as fast as possible. We are in a race against time with extreme drug resistant TB bugs that pose a mortal danger to control in many countries."

Partners In Health played a significant role in overcoming the skepticism and accepted medical wisdom, following the 1994 death from MDR-TB of Father Jack Roussin, a priest and long-time friend of PIH who worked in the shantytowns outside Lima, Peru. At the time, MDR-TB was widely believed to too expensive and too complicated to treat outside of the developed world. In the words of Dr. Mario Raviglione, Director of the WHO Stop TB Department, "MDR-TB was once considered a death sentence for most patients in poor countries."

Setting out to demonstrate both the possibility and imperative for MDR-TB treatment in resource-poor locations, PIH initiated a rigorous program to treat patients with MDR-TB in Lima, Peru. The protocol called for second-line drugs to be provided free of charge and administered under directly-observed therapy by trained community health workers. Cure rates of 85 per cent helped to demonstrate that treatment is not only possible but necessary, both morally and medically, as a way of saving lives and halting the growth of a global epidemic of MDR-TB.

The new guidelines issued in May confirm that treating MDR-TB is "not only feasible but also cost-effective," in the words of Dr. Mark Rosenberg, Executive Director of the Task Force for Child Survival and Development. "Every TB patient should receive timely diagnosis and effective treatment, wherever they live, and whether they are infected with drug-sensitive or drug resistant TB."

A National Public Radio interview with Dr. Jim Yong Kim about the significance of the new MDR-TB guidelines is available online at http://audio.theworld.org/wma.php?id=05104 , as are the "Guidelines for Programmatic Management of Drug-Resistant TB" themselves at http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf . 

[posted June 2006]