Online panel discusses management of second-line anti-TB drugs

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The following is a guest blog post by Sophie Beauvais of The Global Health Delivery Project at Harvard University. Her post discusses the virtual panel discussion they are hosting this week on second-line anti-TB drug management with Dr. Lucica Ditiu from the Stop TB Partnership and several World Health Organization (WHO) experts.

In the fight against multidrug-resistant tuberculosis (MDR-TB) in high-burden areas, program administrators and health workers with limited resources have to get it right when it comes to managing second line drugs (SLD). They are however confronted with many challenges, such as a lack of resources and difficulties in procurement and supply management of SLD; price regulations; or selection of approved manufacturers.

They also struggle with limited funding and political will, despite the global threat caused by increased drug resistance. According to Medecins Sans Frontieres, “…barely 10 percent of the global annual estimate of 440,000 new patients with MDR-TB receive treatment.” Mismanagement of treatment and poor drug quality are the main causes of the spread of drug resistant TB.

“For some of us who have been working in Eastern Europe, TB cases with strains resistant to all drugs tested are unfortunately not a new phenomenon,” said Dr. Masoud Dara, commenting on the recent emergence of a so-called “totally drug-resistant” strain of TB in India. Dara is team leader of the Tuberculosis Program in the Division of Communicable Diseases, Health Security & Environment at WHO Europe and organized the virtual expert panel discussion on managing SLD for drug resistant TB hosted this week on GHDonline.org.  

The March 31 application deadline is looming for the Global Fund to Fight AIDS, Tuberculosis and Malaria Transitional Funding Mechanism, which replaces the Global Fund’s 11th Round of funding, and aims to support  the continuation of essential prevention, treatment and/or care services that the Fund currently finances. No new Global Fund grants will be available until 2014. Meanwhile, TB professionals are debating the answers to these complex SLD questions via the panel discussion.

A few of the issues identified by participants in the online forum thus far include: a lack of quality drug suppliers registered in-country; complicated registration processes for suppliers; a need for assistance and training for that registration process; and a complicated drug import system. Participant Vadim Testov shared that in Russia it took 24 months to negotiate a contract, place an order and receive delivery of the drugs. Similar issues were reported in Ukrain by participant Sergey Strashuk, who noted that finding in-country suppliers for kanamycin and capreomycin is especially difficult, and that manufacturers lose their eligibility status too often.

Dr. Kaspars Lunte, team leader of MDR-TB Supply at the WHO Global Drug Facility, said that countries are moving away from one-time waivers in favor of in-country registrations. “Is there an opportunity at the country level to assist the manufacturers? Is the country willing to fast-track the registration for WHO Pre-Qualified products?,” he asked. Meanwhile patients are not receiving treatment.

Global Fund Portfolio Manager Sandra Irbe commented Thursday that state procurement regulations should not impede procurement of quality assured pharmaceuticals on international market. “If changes in the legislation need to be made, and I think that TB is to be considered as worth the exceptions to the current procurement rules, these legislation changes have to be initiated with immediate effect,” she said. She closed by suggesting that Global Fund grants provide resources for legal assistance to advocate for these changes.

TB professionals have until Friday, February 24 to join this virtual panel discussion (free).

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