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TB Policies in 29 Countries

DR-TB treatment in adults FORMS OF DR-TB The extent of TB drug resistance varies; WHO has defined different forms of DR-TB to help ensure each type is treated as effectively as possible. • Rifampicin-resistant (RR) TB: When resistance to rifampicin is detected using phenotypic or genotypic methods, with or without resistance to other anti-TB medicines 96 • Multidrug-resistant (MDR) TB: TB that is resistant to rifampicin and isoniazid – two powerful, firstline drugs • Pre-XDR-TB: TB that is resistant to isoniazid, rifampicin and either an FLQ or an SLID • XDR-TB: TB that is resistant to isoniazid, rifampicin, any FLQ and at least one SLID

Drug-resistant forms of TB can be acquired or directly transmitted. Several factors drive the development of TB drug resistance, including misdiagnosis leading to ineffective treatment; prescribing, dispensing or dosing errors; substandard medicines; treatment interruptions or poor adherence; medicine stockouts; insufficient medicine levels in the body; and the inability of medicines to penetrate into TB lesions.97 According to epidemiological modelling, without changes to current TB prevention and treatment,

both direct transmission and rates of MDR- and XDR-TB will continue to increase in high-burden countries.98 Drug-resistant forms of TB are more difficult to treat than DS-TB. Until 2016, when WHO released updated guidelines for shorter MDR-TB treatment,99 treatment could last for up to 24 months,1 and involved 8 months of painful daily injections and nearly 15,000 pills, many of which have severe side effects. Undergoing DR-TB treatment is an ordeal for patients, their families and governments. People with DR-TB face the risk of permanent deafness and organ damage from their treatment, as well as catastrophic costs, unemployment, and separation from their families and communities. Worse, they may not survive treatment, as treatment success rates are suboptimal: 52% for MDR-TB and 28% for XDR-TB.1 The price per treatment course ranges from US$ 2,000 to 10 times that amount.1 DR-TB treatment is becoming shorter, less toxic and more effective. New TB medicines and treatment strategies can drastically improve the outcome of DR-TB treatment. Combinations of repurposed medicines that were originally approved for different conditions, companion drugs (that protect against resistance to the main TB medicines), and new TB medicines bring hope to people with all forms of DR-TB.

FINDINGS: All countries have national treatment guidelines that reflect WHO DR-TB treatment guidelines. However, as illustrated in the following sections, countries must still do much more to reduce death and suffering from DR-TB.

Bedaquiline and delamanid Newer, highly effective medicines for MDR-TB have been approved, but few people are benefiting from them.

The first new medicines in nearly 50 years – bedaquiline and delamanid – are only reaching 5% of people who can benefit from these medicines.100 In 2016, only 469 people received delamanid outside of a handful of clinical trials or compassionate use programmes; just over 4,300 people received bedaquiline.101

By the end of March 2017, 8,195 people had received bedaquiline and 496 had received delamanid, all under programme conditions.102 Of all high-burden countries, the largest scale-up of bedaquiline to date has been in South Africa.103 There are several reasons as to why more people have not been able to access these life-saving medicines. Due to limited data, recommendations for the use of bedaquiline and delamanid have been conservative. WHO guidelines recommend that MDR-TB be treated with at least four effective medicines. Bedaquiline and delamanid are recommended as “add-on” agents for people with MDR-TB who do not have other treatment options, and


결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...