You may use this brief for informational, non-commercial purposes with
credit attribution: The Global Health Delivery Project, GHDonline.org,
Jun 02, 2010.
for more information.
Added on 02 Jun 2010
Last updated on 14 Jun 2011
Authors: Julia Fischer-Mackey; Reviewed by Sophie Beauvais and Tim O’Shea
Health providers who do not have access to second-line drugs (SLD) are deeply frustrated at their inability to offer adequate treatment to patients diagnosed with multidrug-resistant tuberculosis (MDR-TB). However, there are many factors besides access to drugs that are key to MDR-TB treatment, and providers should work with their National TB Programs (NTPs) in order to build a sustainable and effective delivery system that allows for better patient retention thus preventing more drug resistance and poor treatment outcome. Members in Indonesia, the Philippines, Taiwan and the Netherlands confront this challenge, exchanging experience on their work with NTPs to develop a comprehensive MDR-TB delivery system.
- Providers should collaborate with their NTPs on MDR-TB treatment, and should only access SLDs through their NTPs.
- High-quality SLDs are expensive and can be difficult to procure. NTPs can apply to the World Health Organization’s Green Light Committee (GLC) to gain access to high-quality second-line anti-TB drugs.
- A comprehensive strategy and infrastructure to ensure adherence to treatment and side effects management is crtiical to ensure completion of therapy. This strategy should include:
- Directly Observed Treatment, Short-course (DOTS)
- an uninterrupted drug supply
patient monitoring through sputum bacteriologic examinations including cultures and Drug Sensitivity Testing (DST)
a reliable laboratory for cultures and DST
capacity to manage and deliver SLDs
a strong hospital-DOTS link to ensure proper cross-referral of MDR-TB suspects
a decentralized, patient-centered treatment delivery system
- Import and distribution of SLDs outside the GLC without a proper system to finance, diagnose and manage patients may result in poor outcomes, additional resistance and unnecessary (and toxic) treatment of drug-susceptible cases. Additionally, drugs procured outside of the GLC may be of unknown quality.
- Procurement Manual for MDR-TB projects under the Green Light Committee mechanism, WHO, 2008, (PDF, English)
- Multidrug and extensively drug-resistant TB (M/XDR-TB) 2010 Global Report on Surveillance and Response, WHO 2010, (PDF, English)
- Scaling Up Programmatic Management of Drug-Resistant Tuberculosis: A Prioritized Research Agenda, Cobelens FGJ, Heldal E, Kimerling ME, Mitnick CD, Podewils LJ, et al. (2008) PLoS Med 5(7): e150. doi:10.1371/journal.pmed.0050150 (Web page, PDF, English, open access)
- A DOTS-Plus Handbook Guide to the Community-Based Treatment of MDR TB, Sonya Shin, Jennifer Furin, Jaime Bayona, Joia Mukherjee, et al., Partners In Health (English, PDF, 17.8MB)
- Guidelines for the programmatic management of drug-resistant tuberculosis, Stop TB Partnership, 2006
Enrich the GHDonline Knowledge Base: Please consider replying to this discussion with the following information
- When this discussion was started in 2008, the GLC was conducting pilot programs of MDR-TB treatment in Indonesia. What has happened since then? What is the status of SLD in Indonesia today?
- How was the MDR-TB treatment program designed and implemented in your country?
- Share tips on working with the GLC
Download: 02_10_11_Treating_MDR_where_SLD_not_Available_.pdf (39.3 KB)