The private tuberculosis (TB) drug market, which has irregular practices could be driving treatment failures and the emergence of drug-resistant TB, according to a research, conducted by the TB Alliance and IMS Health.

Now the private TB drug market is showing to be as large as the public market.

TB reports two million fatal cases annually mostly from the developing world. Sixty per cent of the world’s TB burden is present in the 10 study of the countries of Bangladesh, China, India, Indonesia, Pakistan, Philippines, Russian Federation, South Africa, Thailand, and Vietnam.

One of the drivers of the epidemic is the old and inadequate treatment. The disease is widely considered as a public health concern and its treatment is responsibility of public sector.

Across 10 high-burden countries, there is as much TB drug volume in the private sector as in the public sector. In fact, at least a third of all private sector dosages of first-line TB drugs fall outside of national and international treatment recommendations. Any resulting drug misuse could be responsible for many treatment failures and for escalating the emergence of Multi-Drug-Resistant TB (MDR-TB), which is further worsening the TB epidemic, reports the study.

TB treatment requires lengthy, supervised treatment to maximize cure rates and minimize the development of drug resistance, and in low-income settings this task is thought to be more achievable in the public sector. By contrast, the private sector treatment landscape in these countries is largely unregulated and fragmented; for example, the study detected 111 different first-line TB drug dosages and combinations, compared to the 14 deemed necessary by the Stop TB Partnership’s Global Drug Facility.

“The private sector is keeping alive the confusion that existed previously in the public sector,” said Dr William Wells, the study’s lead author and director of market access at the TB Alliance.

“With this new baseline understanding of the TB drug market, we can no longer ignore the private sector’s critical role in the access equation for TB treatment and in the task of protecting both current drugs and new regimens from the development of resistance, he added.

Four of the high-burden countries covering India, Indonesia, Pakistan, and Philippines had large private sectors. Enough TB drugs are sold in the private sectors to treat all TB patients without even considering the 60 to 80 per cent coverage by the public sector.

“During the past decade, there has been a reawakening of TB drug development efforts. The  first wave of new TB treatments will be introduced within the next few years. But this study fills a critical gap in our knowledge base,” said Dr Mel Spigelman, president and CEO of TB Alliance.

“Most countries covered in this study have Public-Private Mix (PPM) programmes for TB care. Based on country experiences, these programmes have shown good results in optimizing TB management by private care providers. We ought to make private providers responsible partners of the public sector in controlling TB and MDR-TB,” said Mario Raviglione, director,  Stop TB Department at the WHO.

The study has brought to light that the private providers should be supported through accreditation to access to free TB drugs from the public sector and those not doing so should be regulated. More government and international support was to monitor quality of TB drugs. A dual track approach of collaboration and regulation was the logical way forward, added Raviglione.