Ambitious new U.S. plan may put hundreds of thousands on MDR-TB treatment

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The United States plans to place 360,000 multidrug-resistant tuberculosis patients globally on treatment over the next five years, as part of a national tuberculosis action plan currently under draft. The plan – which is due to be submitted to the White House in September – aims to promote universal MDR-TB treatment, accelerate basic TB research, and strengthen domestic capacity to combat MDR-TB, according to Administration officials who discussed the action plan with stakeholders in July.

Presenters at the stakeholders’ forum said the plan aims to leverage existing infrastructure and strengthen existing efforts, collaborations and programs to rapidly implement treatment initiation for MDR-TB patients.

The goal is to initiate 25 percent of the estimated number of people infected with MDR-TB on appropriate treatment in the 20 countries with highest burden in 2016, by 2018 initiate 35 percent of MDR-TB patients on treatment, and by 2020 initiate 50 percent of MDR-TB patients on treatment in the 10 highest burden countries. This will amount to a 60 percent increase in the number of people being initiated on treatment, said Dr. Amy Bloom of USAID.

The portion of the plan that deals with global MDR-TB has two main objectives: improving access to high quality, patient-centered services, and preventing MDR-TB transmission. To improve access to high quality services, the aim is to strengthen the capacity of national TB lab networks to detect drug susceptible and resistant TB, expand and strengthen national care and treatment capacity, enhance surveillance, and strengthen drug availability.

To prevent MDR-TB transmission, the plan aims to remove barriers hindering access to high quality services, improve adherence to treatment programs, and prevent TB transmission within health care settings.

A simplified, shorter treatment regimen is required to achieve these goals and reach such a large number of patients, Bloom said.

Supporting the development of novel drugs and shorter, less toxic, and more effective treatment regimens is one of the research and development goals of the action plan, which includes a goal of supporting clinical trials of shorter treatment regimens. Developing and piloting strategies to improve current treatment outcomes was another goal outlined at the stakeholders’ forum.

Along with improving treatment options, the plan aims to accelerate research to understand genetic diversity of strains and to identify novel biological markers to detect TB progression, for the development of a vaccine and improved diagnosis methods.

The plan also aims to increase the capacity of TB endemic countries to conduct biomedical and clinical research by establishing new clinical sites while expanding existed ones and establishing research training centers.

While the ambitious plan was welcomed by stakeholders, many expressed their concern over the availability of funding to carry out the plan’s goals, pointing out that the Administration has proposed major cuts to the USAID TB program’s budget in recent years.

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