Multi-Drug Resistant Tuberculosis (MDR TB)
Proper treatment of susceptible strains
of TB requires multiple drugs over a six to eight month period.
If therapy is irregular or the drugs are of poor quality,
resistant TB strains become dominant. In the 22 high-burden countries (HBCs) that
have completed national or sub-national TB drug resistance
studies, rates of multi-drug resistant (MDR) TB range from
0 -10 percent in infectious cases that have not been previously
treated; levels are
generally higher in previously treated cases. Even in non-high
burden countries, high MDR rates pose serious threats to
the local population. This situation is a concern because
drug-resistant TB is more difficult to cure, which translates
into greater disease transmission and higher death rates.
Second line drugs used to treat MDR TB are often toxic
and disabling to patients. The cost of treating MDR TB
ranges from 10 to 100 times greater than it is for drug-susceptible
TB, which has implications for both health budgets and
patient access to care.
USAID supports a two-fold approach to address MDR TB. USAID supports the strengthening of DOTS programs to improve adherence to recommended treatment regimens and to prevent the emergence of MDR TB. USAID assistance is providing improved procurement and management of high-quality drugs, and strengthening routine monitoring of drug quality. In addition, USAID supports interventions to improve the treatment of MDR TB. Attention is given to better monitoring and recording of treatment failures, implementing studies to measure TB drug resistance, expanding laboratory capacity to monitor drug-resistance, introducing new drugs and/or treatment regimens, and supporting operations research (such as DOTS Plus for MDR TB pilot projects) to reduce poor outcomes. Expanding the involvement of the private sector in DOTS is addressed as well, since TB treatment by private health providers is often inconsistent with the recommended drug regimens (e.g. type of drug, dose, and duration) and drug quality standards.
USAID also supports training of private sector providers
to raise their awareness of DOTS, as well as programs that link private sector
providers with the national TB program. Finally, USAID supports the development
of a tracking tool to assist the Green Light Committee (GLC) in scheduling
shipments, monitoring drug inventory, and identifying technical support required
for the GLC to carry out its expanded role as the procurement and distribution
mechanism for GFATM grants awards involving second line TB drugs.
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