World TB Day 2012: Ensuring a Treatable Disease Is Actually Treatable

Our most daunting global health crisis is a pernicious, wasting disease that can be spread by a simple cough or sneeze and has been infecting humans since 4,000 B.C.
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Our most daunting global health crisis is a pernicious, wasting disease that can be spread by a simple cough or sneeze and has been infecting humans since 4,000 B.C.

Tuberculosis (TB) -- a treatable and curable condition -- continues to grow in prevalence, mostly in the developing world, but even in pockets throughout Europe. The World Health Organization (WHO) has declared it a global health emergency.

But it's the drug-resistant forms of the disease, MDR-TB (multidrug-resistant) and XDR-TB (extensively drug-resistant) -- which are constantly mutating and require treatments so onerous that nearly one-third of all patients die -- that pose the most serious cause for concern.

Drug-resistant TB is thriving because we have failed to adequately detect and treat ordinary TB. This is, sadly, a problem of our own creation. Our efforts to treat regular TB are insufficient, with many people interrupting or only erratically maintaining adherence to lengthy treatment regimens which themselves are often based on diagnostic tests that predate the Model-T. New drugs that can treat TB and drug-resistant TB more quickly, simply, and cost-effectively are urgently needed.

XDR-TB has now been reported in 69 countries, but it's likely under-reported, as very few endemic countries have the laboratory capacity to detect drug resistance. This is particularly challenging in countries that lack optimal healthcare systems in Africa, Asia and South America. And once a drug-resistant strain emerges, it can be transmitted directly to others just like ordinary TB. We now understand that direct transmission is the most common way drug-resistant TB is spread, which augments this emerging global health threat.

The combination of TB and HIV/AIDS exacerbates the situation. HIV/AIDS makes you more susceptible to TB, which itself makes HIV/AIDS worse. TB is the No. 1 infectious killer of people living with HIV/AIDS -- meaning that our failure to stop the spread of drug-resistant TB threatens the significant progress that has been made in the fight against HIV/AIDS.

There is no single technology that exists today to address all TB diagnostic needs; complementary diagnostics, both molecular and liquid culture, are required to diagnose patients with active TB and determine which drugs their TB is sensitive to. With a new diagnostic tool, more appropriate treatment could be given more quickly. But there is cause for hope. Significant advances are being made in designing rapid and accurate diagnostic technologies. And innovative partnerships between companies, governments and health advocacy organizations are helping to ensure that these advances reach endemic regions.

These comprehensive approaches -- coupled with partnerships to improve health system capacity by providing training for frontline healthcare workers, improving laboratory services and processes, and providing the latest diagnostic tools to laboratories in countries most threatened by TB at deeply discounted prices - are helping to make a difference.

Building on an existing partnership, the Foundation for Innovative New Diagnostics (FIND) and BD recently announced a new collaboration to promote access to early and accurate diagnosis of MDR-TB among HIV-infected patients and other vulnerable populations in India, a country that accounts for nearly 25 percent of TB cases globally.

The pilot program will be launched in Karnataka state, the region with the highest TB/HIV co-infection rate in the country. The program will focus on increasing access to state-of-the-art diagnostics by extending an existing pricing agreement that significantly reduces the price of the BD BACTEC™ MGIT™ system. The initiative, in partnership with Kasturba Medical College, also seeks to establish a new collaboration model in which a private hospital provides critical medical services to public patients. Having access to private healthcare systems will help ensure that the patients facing the greatest risk of TB -- and the greatest risk of co-infection and drug resistance -- are being cared for by the best their community has to offer.

According to the WHO, each year approximately 2 million people in India develop TB -- that's one in every five TB cases on the planet. If we can pave the way to reversing and defeating TB in India, we'll make a monumental dent in TB globally.

And more help is on the way. The global TB drug and vaccine pipelines are more robust than ever before. A partnership including the TB Alliance, Bayer HealthCare, University College London, University of St. Andrews and the U.K. Medical Research Council recently announced the completion of patient enrollment in REMox TB, a global Phase III clinical trial, which may result in the registration of the first new drug approved to treat drug-sensitive TB in nearly 50 years. Additionally, new, novel drug regimens with the potential to dramatically shorten treatment for MDR-TB by 80 percent or more are currently being tested.

We need to keep collaborating to end TB. It can be diagnosed. It can be treated. We can defeat it. But it starts with political will to fund TB efforts, public and private sector scientific collaborations to produce the next generation of TB vaccines, diagnostics and treatments, and high-impact health partnerships to ensure access for all and amplify their impact to end the latest global health crisis.

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