What will it take to eliminate drug-resistant tuberculosis?

Abstract

Summary Drug resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but that is slowly changing. If the world is to drastically reduce the incidence of DR-TB, we must stop creating new drug-resistant TB as an essential first step. The drug-resistant TB epidemic that is ongoing must also be directly addressed. First-line drug resistance must be rapidly detected through 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 tests, 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, but achieving this goal will require substantial global investment plus political and societal commitment at the national and local levels.

Tuberculosis care cascade in Zambia - identifying the gaps in order to improve outcomes: a population-based analysis

“…While the implementation of existing diagnostic tools as well as improved DR-TB treatment regimens must be optimised, there remains a continued need for the development of rapid low-cost DST that can be scaled up to provide decentralised access to first-line and second-line DST aligned with current treatment recommendations, 62 as well as continued progress towards shorter, less toxic and more effective DR-TB treatment regimens. 63 …”

Projecting the impact of variable MDR-TB transmission efficiency on long-term epidemic trends in South Africa and Vietnam

“…A better understanding of these dynamics in human populations will improve our ability to predict (and possibly prevent) increases in the burden of MDR-TB. In the meantime, specific investment in responses specific to MDR-TB (such as expanded DST coverage, enhanced case finding, improved MDR-TB therapies, and focused political and economic commitment 44 ) should be prioritized, given the potential for substantial spread in the future.…”

Validation of Differentially Expressed Immune Biomarkers in Latent and Active Tuberculosis by Real-Time PCR

“…Noncompliance with anti-mycobacterial therapies contribute to difficulties in disease eradication (25,45,46). The treatment for TB is lengthy and patient compliance to long-term drug treatment is varied, with patients often stopping therapy when their symptoms cease (1,(47)(48)(49)(50). Failure to complete the treatment regimen promotes the development of multi drug resistance (25,(51)(52)(53)(54) and contributes to ongoing barriers for disease eradication (14,(55)(56)(57).…”