It can be “more challenging than the disease” itself. For example, in October 2014, Dilip Kadam committed suicide as he awaited MDR-TB treatment at Mumbai’s Sewri Tuberculosis Hospital.
It was his second suicide attempt of the day. Just hours earlier, Dilip had slashed himself with a razor, which doctors then confiscated—not knowing he had a second one hidden.
Tragically, the hospital is no stranger to suicide attempts by MDR-TB patients, who struggle with a form of TB that does not respond to many drugs and can take years of treatment to cure.
In honor of World TB Day on March 24, Citizen News Service and The Union would like to focus this month’s briefing on the issue of drug resistance in the world’s struggle against TB.
World TB Day
World Tuberculosis (TB) Day marks the day in 1882 when Dr. Robert Koch announced that he had discovered TB bacillus, the agent that causes TB. Koch’s discovery paved the way for diagnosis and treatment of TB, which at that time caused one in seven deaths in Europe and the United States. One hundred years after Dr. Koch’s announcement,
The Union and the World Health Organisation (WHO) sponsored the first World TB Day to raise awareness about the daily disease.
World TB Day is now recognized every year by all United Nations member states, and this year’s theme is “Unite to End TB.” The purpose is to unite “individuals and communities in new ways to end the tuberculosis (TB) epidemic.”
Today, TB kills more people than any other infectious disease, surpassing HIV/AIDS in number of deaths in 2015. Although it is curable and preventable, TB took 1.5 million lives in 2014. 95% of those deaths took place in low- and middle-income countries, disproportionately affecting poorer regions of the globe.
While over 2 billion people have latent—or inactive—TB infections, in 2014 over 9 million people developed active TB disease, in which they suffered symptoms such as cough with sputum and blood, chest pains, weight loss, and fever, as well as were able to pass the disease on to others through the particles that emerge from their lungs into the air during a cough.
In 2014, about 480,000 people were estimated to have contracted MDR-TB—the majority of them in India, China, and Russia—and 190,000 people died from these drug-resistant strains. , An estimated 9.7% of these MDR-TB cases are extensively-drug resistant TB, which has been reported so far in 105 countries.
MDR-TB is any strain of TB that does not respond to isoniazid and rifampicin, two key anti-TB drugs used in standard or first-line treatment. More rigorous treatment can cure MDR-TB, but the stronger second-line drugs are more costly and less available than first-line drugs.
Patients often endure severe side effects (such as ototoxicity, psychiatric disorders, and gastrointestinal disturbance) from the potent drug combinations that make up second-line treatment. These side effects can remain even after the patient is cured of TB. Ototoxicity, for example, can lead to deafness that lasts the patient’s lifetime.
Drug resistant strains of TB have been on the rise throughout the world in recent years, primarily due to inappropriate treatment. If clinic or medical staff are improperly trained in administering or storing drugs, if doctors prescribe ineffective treatment regimens, or if people living with TB do not complete treatment regimens or end their treatment early, the TB in patients’ bodies can develop drug resistance.
Poor quality medicines—whether falsified medicines or genuine medicines that have been allowed to degrade—can also contribute to drug resistance. This drug resistant TB can then transmit from person to person—and MDR-TB does so effectively in crowded places like hospitals and prisons.
In some cases, strains of TB can develop even more drug resistance and become the form called extensively drug-resistant tuberculosis, or XDR-TB. TB strains that are extensively drug-resistant are multidrug-resistant and show resistance to two or more classes of second-line drugs. Researchers in South Africa in 2011 and India in 2012 discovered that a number of XDR-TB patients showed resistance to all anti-TB drugs available in their countries at the time.
Yet while more energy must be put into confronting drug resistance as an integral part of the global health community’s anti-TB strategy, progress is already being made.
For example, The Union, the US Agency for International Development, Janssen Research & Development, and the UK Medical Research Council are collaborating on an ongoing clinical trial called STREAM, which is focused on shortening treatment regimens for MDR-TB. If successful, new regimens could shorten treatment time from two years to 6-9 months and consist of all-oral medication, removing the need for painful daily injections.