MDR-TB Diagnosed Rapidly in Low-Resource Countries

It will become possible to diagnose people in low-resource countries who are ill with multidrug-resistant tuberculosis (MDR-TB) two days, rather than the standard two to three months.

MDR-TB is a form of TB that responds poorly to standard treatment because of resistance to the first-line drugs isoniazid and rifampicin. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services.

New initiatives unveiled by the World Health Organization (WHO; Geneva, Switzerland), the Stop TB Partnership (Geneva, Switzerland), UNITAID (Geneva, Switzerland), and the Foundation for Innovative New Diagnostics (FIND; Geneva, Switzerland) should increase that proportion at least seven-fold over the next four years, to 15% or more.

In developing countries most TB patients are tested for MDR-TB only after they fail to respond to standard treatments. Then it takes two months or more to confirm the diagnosis. Patients have to wait for the test results before they can receive second-line drugs. During this period, they can spread the multidrug-resistant disease to others. Often the patients die before results are known, especially if they are human immunodeficient virus (HIV)-infected in addition to having MDR-TB.

The initiative comes one week after WHO recommended line probe assays for rapid MDR-TB diagnosis worldwide. This policy change was driven by data from recent studies, including a large field trial conducted by FIND together with South Africa's Medical Research Council (Tygerberg, South America) and the National Health Laboratory Services (Johannesburg, South America). The results of this trial produced evidence for the reliability and feasibility of using line probe assays under routine conditions.

The new initiative consists of two projects. The first, made possible through US$26.1 million in funding from UNITAID, will introduce a molecular method to diagnose MDR-TB that until now was used exclusively in research settings. These rapid, new molecular tests, the line probe assays, produce an answer in less than two days.

WHO's Global Laboratory Initiative and FIND will help countries prepare for installation and use of the new rapid diagnostic tests, ensuring necessary technical standards for biosafety and the capacity to accurately perform DNA-based tests. One country, Lesotho, is already equipped to start using these tests; Ethiopia is expected to be ready by the end of 2008. The tests will be phased in during 2009-2011 in another 14 countries.

The second, complementary agreement with UNITAID for $33.7 million will boost the supply of drugs needed to treat MDR-TB in 54 countries, including those receiving the new diagnostic tests. This project is also expected to achieve price reductions of up to 20% for second-line anti-TB drugs by 2010.

The current British Prime Minister, Mr. Gordon Brown, who helped launch the Stop TB Partnership's Global Plan to Stop TB in 2006, and whose government is a founding member of UNITAID said, The UK is committed to stopping TB around the world, from our funding of TB prevention programs in poor countries, to our support of cutting edge research to develop new drugs.


Related Links:
Stop TB Partnership
UNITAID
Foundation for Innovative New Diagnostics