What will it take to eliminate drug-resistant tuberculosis?

• Authors: Emily A. Kendall, Johns Hopkins University; Suvanand Sahu, Stop TB Partnership; Madhukar Pai, McGill University; Greg J. Fox, University of Sydney; Francis Varaine, Medecins Sans Frontieres; Helen Cox, University of Cape Town; J. Cegielski, Emory University; Lynette Mabote, AIDS & Rights Alliance Southern Africa; Anna Vassall, London School of Hygiene & Tropical Medicine; David W. Dowdy, Johns Hopkins University
• Journal Title: The International Journal of Tuberculosis and Lung Disease
• Volume: Volume 23, Number 5
• Publisher: International Union Against Tuberculosis and Lung Disease | 2019-05-01, Pages 535-546
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.5588/ijtld.18.0217
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Respiratory System; drug resistance; elimination; incidence reduction; prevention; cost effectiveness; MYCOBACTERIUM-TUBERCULOSIS; COST-EFFECTIVENESS; SUSCEPTIBILITY TEST; XPERT MTB/RIF; MDR-TB; TRANSMISSION; HEALTH; BEDAQUILINE; REGIMENS; IMPACT

Abstract

The Union Drug-resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but this situation is slowly changing. If the world is to drastically reduce the incidence of DR-TB, we must stop creating new DR-TB as an essential first step. The DR-TB epidemic that is ongoing should also be directly addressed. First-line drug resistance must be rapidly detected using universal molecular testing for resistance to at least rifampin and, preferably, other key drugs at initial TB diagnosis. DR-TB treatment outcomes must also improve dramatically. Effective use of currently available, new, and repurposed drugs, combined with patient-centered treatment that aids adherence and reduces catastrophic costs, are essential. Innovations within sight, such as short, highly effective, broadly indicated regimens, paired with point-of-care drug susceptibility testing, could accelerate progress in treatment outcomes. Preventing or containing resistance to second-line and novel drugs is also critical and will require high-quality systems for diagnosis, regimen selection, and treatment monitoring. Finally, earlier detection and/or prevention of DR-TB is necessary, with particular attention to airborne infection control, case finding, and preventive therapy for contacts of patients with DR-TB. Implementing these strategies can overcome the barrier that DR-TB represents for global TB elimination efforts, and could ultimately make global elimination of DR-TB (fewer than one annual case per million population worldwide) attainable. There is a strong cost-effectiveness case to support pursuing DR-TB elimination; however, achieving this goal will require substantial global investment plus political and societal commitment at national and local levels.