Challenges to the global control of tuberculosis

Abstract

ABSTRACT

Ethical Issues in Tuberculosis Control

“…However, despite disease-oriented point program suggested by the WHO for TB, success rate of treatment of multidrugresistant TB, as of today, is 48%, the rate of treatment discontinuation is 28%, death is 15%, and failure is 10% [16,17]. That is to say, success rate achieved in the treatment of multidrug-resistant TB is close to the "success" that would be achieved by not implementing a TB-oriented treatment.…”

“…The first of these problems is demonstration of the fact that TB burden calculations based on data from the WHO might be indefinite, sometimes even deceptive [16]. In addition, cases diagnosed with and treated for TB are not being reported to the national TB programs.…”

“…Market-profit problems are encountered with expensive drugs used in the treatment of multidrug-resistant TB patients. Besides all these, financial support provided by the organizations such as Global Fund for Struggle against AIDS, TB and Malaria is inconsistent, and the funds that come from these organizations are sometimes cancelled and only 54% of the cases infected with HIV could reach to appropriate antiretroviral therapy in the countries with low-moderate income [16]. Finally, it is known that the leading problems encountered by TB patients at the stage of diagnosis include absence of health insurance, inability in accessing to health care services, and low-quality activity of laboratory network [17].…”

“…More importantly, disease-oriented point program that has been put into use under the leadership of WHO will not be able to achieve the goals set for 2015 and 2050. No doubt, correction of this bad situation is possible not by putting disease-oriented point programs and technical components into use as has been until today, but only by raising the health system to the adequate level as a whole, by taking social determinants of the disease into account, by meeting the needs of poor and fragile groups [16].…”

Multidrug-resistant and extensively drug-resistant tuberculosis: a review of current concepts and future challenges

“…1 Treatment scale-up is limited by the paucity of trained staff, second-line drugs, facilities for treatment and monitoring, and by weaknesses in the coordination of programmatic TB management. 49 A major impediment to treatment scale-up is the cost of treatment and availability of drugs. A recent report quoted the cost of a standard MDR-TB treatment regimen, based on the 2011 WHO guidelines and using WHO prequalifi ed drugs suppliers, of between US$2,909 and US$4,014, using capreomycin, moxifl oxacin, ethionamide, pyrazinamide and cycloserine.…”