The Wall Street Journal examines global efforts to stop the spread of drug-resistant tuberculosis (TB) strains, stating, “Global health officials view the emergence of incurable cases of tuberculosis in India as a worrisome evolution in a trend they have been concerned and intensely frustrated about for years — the rise of drug resistant forms of tuberculosis around the world.” The newspaper notes that “last year, a Mumbai doctor reported several cases of TB resistant to the 12 most commonly used medicines,” and adds that “[a]s many as 4.8 percent of all tuberculosis cases are resistant to at least some available drugs, according to a recent study.” The newspaper discusses WHO guidelines to prevent the spread of TB and writes, “Lucica Ditiu, executive secretary of the Geneva-based Stop TB Partnership, an advocacy organization whose members include the World Health Organization, the CDC and others, says only localized action by the countries themselves will bring rates of drug-resistant TB down” (Shah/Anand/McKay, 9/7).
“[O]ver the past month, [tuberculosis (TB)] has captured high-profile attention from the Washington Post, the New York Times, TIME, NPR, [Agence France-Presse] and other major media, generating big headlines about the rising challenge we face in tackling one of humanity’s oldest and most resilient infectious diseases,” Jan Gheuens, interim director of the Bill & Melinda Gates Foundation’s TB Program, writes in the foundation’s “Impatient Optimists” blog. “Why should we be concerned?” he asks. Gheuens says because the worldwide number of multidrug-resistant TB (MDR-TB) cases is growing; “it costs a lot of money to treat MDR-TB”; and “MDR-TB patients must go through two years of intensive treatment, including daily injections for the first six months.” He concludes, “What’s clear now, more than ever, is that making progress on TB will require a comprehensive approach that includes new and better approaches to diagnosis, treatment, and prevention” (9/6).
In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health “seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy,” they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, “[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, “In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.”
The Washington Post examines how the “discovery of an almost untreatable form of tuberculosis [TB] in India has set off alarm bells around the world and helped spur a dramatic expansion of government efforts to battle the killer lung disease.” The newspaper writes, “For the past decade, a nationwide tuberculosis program involving millions of health workers and volunteers has made slow but significant progress in battling the disease in India and has been hailed as a public health success story,” but “any sense of complacency was dispelled in December when a doctor in Mumbai, Zarir Udwadia, discovered a strain of the disease that did not respond to any of the 12 frontline drugs.”
PlusNews examines the recently approved grants under the Global Fund to Fight AIDS, Tuberculosis and Malaria’s Transitional Funding Mechanism (TFM), stating, “Last week, the Fund announced that 45 new grant applications, from countries such as Burundi, Malawi and Swaziland, have been approved under the TFM.” The news service notes, “Almost 25 percent of this combined total will go towards [tuberculosis (TB)], which represents a significant increase from the average 16 percent of funds allocated for TB since the Global Fund was created in 2002, according to a StopTB Partnership statement released in response” to the fund’s announcement. PlusNews notes, “Unlike regular grants, which can run for up to five years, those awarded under the TFM will be limited to two years, by which time the fund is expected to have launched its new funding model” (9/4).
The Center for Global Health Policy’s “Science Speaks” blog profiles Bernard Rivers, founder and executive director of Aidspan, a watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, who is leaving his position after 10 years. “He will not be running Aidspan anymore, but plans to continue to research and write about Global Fund issues,” the blog states. In the blog, Rivers discusses his motivation behind founding Aidspan and his hopes for the future of the Global Fund (Barton, 8/30).
U.S. Ambassador to Nigeria Terence McCulley spoke on Monday in Abuja at the inauguration of a Defense Reference Laboratory, Leadership reports, noting he said the laboratory, “which is the first of its kind in the sub-region,” was supported by U.S. funding. According to the newspaper, McCulley said the Reference Laboratory Program is part of U.S. assistance to Nigeria through a partnership between the U.S. Department of Defense (DOD) and Nigeria’s Ministry of Defense (NMOD) through the Walter Reed Program (WRP-N) and the Emergency Plan Implementation Committee (EPIC), which began in 2005 (8/30).
In a study published on Wednesday in the Lancet, researchers from the Centers for Disease Control and Prevention found that “[a]mong 1,278 patients who were resistant to two or more first-line tuberculosis drugs in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea and Thailand, 43.7 percent showed resistance to at least one second-line drug,” which “suggest[s] the deadly disease may become ‘virtually untreatable,'” according to the study, Bloomberg Businessweek reports (Kitamura/Narayan, 8/29). “In about a fifth of cases, they found resistance to at least one second-line injectable [versus oral] drug,” according to Reuters, which states “[t]his ranged from two percent in the Philippines to 47 percent in Latvia.” Overall, 6.7 percent of patients had extensively drug-resistant TB (XDR-TB), meaning patients are resistant to the first-line drugs isoniazid and rifampicin as well as drugs in the fluoroquinolone antibiotic class and a second-line injectable antibiotic, Reuters adds, noting “[r]ates in South Korea, at 15.2 percent, and Russia at 11.3 percent, were more than twice the WHO’s global estimate of 5.4 percent at that time” (Kelland, 8/30).
“The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has approved 45 new two-year grants, from 37 countries, totaling $419.2 million, to fund essential prevention, treatment, and care services provided to the people affected by the three diseases,” according to a Global Fund press release. “Another 11 proposals worth a total of $91.2 million were sent back for revision, and are subject to a further independent technical review before they can be approved,” the press release adds, noting the grant approvals are part of the Transitional Funding Mechanism and “will bridge the financing of essential interventions until the next opportunity to apply for grants” (8/28). According to the U.N. News Centre, the Global Fund “has approved funding of $22.9 billion for more than 1,000 programs in 151 countries, and helped programs provide AIDS treatment for 3.6 million people, anti-tuberculosis treatment for 9.3 million people, and 270 million insecticide-treated nets for the prevention of malaria” (8/28).
Small, Ingestible Sensor Can Track Patient Medication Intake, Activity Levels; Technology To Be Tested For TB Treatment
The FDA last month approved for use a small ingestible sensor that, when embedded into a pill, can help “keep track of whether a patient is taking their medicine on time,” Reuters reports. “The digital feedback technology, devised by Redwood City, California-based Proteus Digital Health Inc., can also prompt patients to take their medicine and even ask them to take a walk if they have been inactive for too long,” the news service writes. “Proteus has a partnership with the Bill & Melinda Gates Foundation and China’s Center for Disease Control and Prevention to test the technology in tuberculosis treatment,” Reuters notes, adding, “Pills for anything from the common cold to diabetes or cancer can be embedded.”