Developing Countries Struggle to Finance and Enforce Tuberculosis Treatment, Leading to Drug-Resistant Super-Strains

Developing Countries Struggle to Finance and Enforce Tuberculosis Treatment, Leading to Drug-Resistant Super-Strains

LONDON, UK (GlobalData), 21 March 2013 - Our approach towards tuberculosis (TB) treatment plays an essential part of the global fight against the disease, argue GlobalData's expert healthcare analysts, but resource-poor countries may struggle to maintain the extensive drug programs required.

A century ago infection with certain bacterial pathogens, such as Mycobacterium tuberculosis, was akin to a death sentence, but medical discoveries have radically transformed survival rates. However, TB is still responsible for over one million deaths each year, and is an escalating medical concern, especially in low-income countries.

The excessive use and abuse of popular therapeutics has driven bacterial evolutionary mechanisms to develop drug-resistant strains, such as multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). The World Health Organization (WHO) expects the occurrence of MDR-TB to continue  increasing steadily in the near future , accounting for over 25%, or US$2 billion, of treatment cost around the world by 2015 . This growing concern highlights faltering patient compliance rates, which in turn dictate drug resistance. The need for novel medication is imperative, but perhaps more importantly, attitudes need to change towards the adherence to disease treatment.

GlobalData's Infectious Disease analyst, Dr. Christopher Pace, states: "Healthcare providers typically supervise the first two months of TB therapy, but during the four-month continuation phase patients are expected to self-medicate. Failure to adhere to daily treatment often results in the appearance of MDR-TB, which requires up to 20 months of antibiotic treatment. The long-term cost-effectiveness and public health benefits of improved patient compliance would therefore seriously outweigh any short-term obstacles. In developing nations, programs such as the WHO's Directly Observed Treatment, Short-course (DOTS) set standards of care that seek to improve patient compliance and the government's role in TB therapy."

However, GlobalData's analyst covering infectious diseases, Dr. Brad Tebbets, explains that strict adherence to TB treatment is easier said than done in a context of poverty. He says: "Low- and middle-income countries are disproportionately affected by TB, and these countries rely heavily on international donations and public-private partnerships to support their disease treatment and control efforts, with The Global Fund to Fight AIDS, TB, and Malaria providing almost all of this support. The WHO reports that these programs will require twice the current investment over the next three years if they are to succeed, and the on-going economic concerns in the US and EU make it unlikely that these countries will increase their contributions."

The treatment of HIV in developing countries may act as an inspiration for TB therapeutics. The number of people in sub-Saharan Africa receiving antiretroviral treatment has seen a 100-fold increase since the last decade, according to UNAIDS, reaching 6.2 million people in July 2012. First line HIV treatment has dropped from an annual cost of close to US$10,000 per person in 2000 to less than US$100 today, playing no small part in this uptake.

GlobalData's analyst covering infectious diseases, Dr. Charalampos Valmas, explains: "Generic manufacturers enjoy a unique approval process under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), with tentative approval by the FDA aiming for the expedited approval of generic drugs in countries severely burdened by HIV.  The medicines patent pool (MPP) also works with patent holders that voluntarily contribute their patents to MPP to foster collaboration with generics manufacturers to produce drugs. Leading companies in the antiretrovirals market, such as ViiV Healthcare and Gilead Sciences, serve as contributors to MPP. This allows expanded access to their drugs where they are mostly needed, helping to cut the increase of drug-resistance and mortality."

Commentary was provided by GlobalData's Infectious Disease analysts, Dr. Christopher Pace, Dr. Brad Tebbets, and Dr. Charalampos Valmas. For more information, or to request an interview, please contact our press office at [email protected]
For more information, or to request an interview, please contact our press office at [email protected]

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