USAID’s Response to
Extensively Drug-Resistant Tuberculosis (XDR TB)
What is XDR TB?
Extensively drug-resistant TB (XDR TB) is a form of tuberculosis resistant to most of the currently available anti-TB drugs. In technical terms, it is multidrug-resistant TB (MDR TB) that is resistant to at least two of the most powerful first-line anti-TB drugs as well as two of the three most important second-line anti-TB drugs. XDR TB is more difficult to diagnose and treat and potentially fatal. An outbreak of XDR TB in KwaZulu-Natal, South Africa, caused high mortality rates in which 52 out of 53 patients died on average less than a month after diagnosis. XDR TB also threatens to undermine the progress made in global TB control in recent years.
What is known about XDR TB?
XDR TB has been confirmed in all regions of the world and in all G-8 countries, including the United States. The World Health Organization (WHO) estimates that each year there are about 420,000 cases of MDR TB, of which approximately 6 percent are XDR TB. The XDR TB burden appears to be highest in countries with high MDR TB. It is estimated that over 60 percent of MDR TB is found in China, India, and Russia. However, the actual burden of XDR TB is unknown, as most countries lack adequate clinical, laboratory, and surveillance capacity to investigate, document, and report cases.
What is USAID doing about XDR TB?
In South Africa, the United States Agency for International Development (USAID) has reprogrammed funds to respond to the emergency. Working with the national TB program (NTP), USAID is providing training in treatment of MDR/XDR TB, assisting with contact tracing and supporting an investigation into the emergence of XDR TB and its association with HIV/AIDS in KwaZulu-Natal. USAID also helps the NTP to enhance national surveillance of MDR/XDR TB and to strengthen infection control measures and laboratories. USAID also worked with the U.S. Centers for Disease Control and Prevention (CDC) and the South African Department of Health to establish the Africa Regional International Training and Research Center on MDR TB and HIV that was launched in March 2006.
USAID’s response to XDR TB builds on its long-standing and ongoing investments to control TB and MDR TB globally. USAID’s work is consistent with the recommendations of the draft WHO Global MDR TB and XDR TB Response Plan 2007. In collaboration with its partners, USAID’s programs:
- Strengthen and expand basic TB control programs to improve the quality of services. This is USAID’s highest priority and the most effective way to prevent the development of MDR TB and XDR TB. USAID’s funding to the STOP TB Partnership’s Global TB Drug Facility supports grants for quality-assured anti-TB drugs to countries in need.
- Build surveillance and laboratory capacity to detect TB and drug-resistant TB strains quickly and accurately. USAID supports TB surveillance in developing countries, rapid surveys in high-risk countries, the establishment of supranational reference laboratories, and introduction of rapid diagnostic tests.
- Scale up infection control measures. USAID supports the development of national infection control guidelines and improvements to health facilities and laboratory infrastructure to reduce the risk of transmission of disease.
- Increase capacity to treat and manage MDR TB and XDR TB. USAID provides technical assistance and training to national staff in the diagnosis and treatment of drug-resistant TB, surveillance, infection control, outbreak response, and drug management. USAID supports the Green Light Committee, which helps countries access second-line TB drugs at reduced prices if they improve the management of their MDR TB programs.
- Train community members to help patients complete their treatment.
- Support research on new drugs, drug regimens, and diagnostics, as well as innovative approaches to improve the quality and effectiveness of TB programs.
Who are USAID partners?
Country level: National TB programs – USAID works closely with national programs to address gaps in TB and MDR TB control programs. USAID works with the U.S. President’s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) in focus countries to provide guidance and technical assistance on issues related to HIV/TB co-infection
Regional level: Regional organizations and institutions – USAID’s work includes partnerships with Centers of Excellence in Latvia and South Africa, supranational reference laboratories, and WHO regional offices.
Global level: The Global XDR TB Task Force, WHO, CDC, TB Control Assistance Program, Rational Pharmaceutical Management Plus, PATH, United States Pharmacopeia Drug Quality and Information, and Gorgas TB Institute.
Research partners: The Global Alliance for TB Drug Development, WHO/Tropical Disease Research, CDC, and the International Union Against TB and Lung Disease.
Where will I find more information about XDR TB?
For more information about XDR TB and the global response, visit the WHO Web site.
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