A promising new diagnostic test will finally help detect more people with Drug-Resistant Tuberculosis (DR-TB), increasing the urgency to solve major problems around the pricing and supply of DR-TB medicines, according to a new report by the international medical humanitarian organisation Médecins Sans Frontières (MSF).
 
DR-TB is on the rise, but less than 7% of 440,000 new cases each year receive treatment, and DR-TB kills 150,000 people in the world annually according to the WHO. India is one of the countries with the highest burden of DR-TB cases in the world, with more than 99,000 new cases in India each year.

MSF’s report, released on World TB Day, shows that DR-TB drugs are riddled with persistent supply and price problems that must be urgently addressed.  The report examines medicines used to treat DR-TB according to the number of suppliers, quality assurance and price, based on information obtained from the Global Drug Facility and drug manufacturers.

The report highlights that four of the recommended DR-TB medicines are available from only one quality-assured generic source. Relying on a sole supplier whose production could be disrupted or stopped at any time always carries a risk of dangerous treatment interruption for patients. For example, supplies of the injectable drug kanamycin were disrupted during 2010, leading to a temporary global stock out.

“In India and several other countries, resistance to TB drugs is a serious public health issue which cannot be allowed to get worse,” said Blessina Kumar of Stop TB Partnership. “Patients have been stuck in a vicious circle – not enough people are diagnosed, and drug supply problems along with high prices stand in the way of putting more people on treatment.”

Additionally, MSF’s report found that several DR-TB medicines are very expensive, with prices for two drugs having increased by more than 600% and one drug by more than 800 per cent over the last decade. A 24-month DR-TB treatment regimen can cost as much as US$9,000 for one patient – 470 times more than the $19 per patient it costs to cure standard, drug-sensitive TB.

“Now that we have a new test that can detect DR-TB in less than two hours instead of three months, we’re going to see many more people who will need reliable drug supplies to get treated,” said Joanna Ladomirska, medical co-ordinator for MSF in India. “We need to see some immediate action to improve access to DR-TB drugs so that more people are started on treatment and transmission of this disease is reduced. This is particularly important in India, given the high burden of DR-TB here,” said Ladomirska.

The low demand for DR-TB drugs has made the market unattractive for producers, which is reinforcing supply and price problems. One way to kickstart increased production of some of these drugs is for donors to guarantee purchase volumes for several years to producers upfront. Other mechanisms such as better forecasting of the mid- to long-term needs for DR-TB drugs are also needed to help attract more producers to the market, to improve supply security and increase competition that helps brings prices down.

“With faster diagnosis and better treatment models of DR-TB, we need to fix the supply and price issues with DR-TB drugs. We also need to see newer drugs developed,” said Ladomirska.

In 2010, MSF treated close to 30,000 people with TB in 29 countries, and 1,000 patients with DR-TB. Projects where MSF treats DR-TB range from prisons in Kyrgyzstan to urban contexts in India and HIV-endemic settings such as Swaziland and South Africa. MSF has developed treatment strategies that are adapted to individual contexts, often providing treatment in the community through ambulatory care models so as to reduce the burden on patients and boost adherence to treatment.

In the Khar district of Mumbai MSF runs a centre which provides treatment to people living with HIV, including treatment of co-infections, such as DR-TB.