Feature story

Call for global action on the threat of drug-resistant tuberculosis

03 April 2009

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Dr. Bernhard Schwartländer, UNAIDS Country Director for China, chaired a session on TB/HIV at the meeting.

Ministers from the 27 countries with the highest burden of multi-drug resistant and extensively drug-resistant tuberculosis (M/XDR-TB) have jointly endorsed a Call for Action on TB control and care to urgently address this alarming threat. The meeting in Beijing, China, on 1-3 April 2009, was organized by the World Health Organization (WHO), the Ministry of Health of the People's Republic of China and the Bill & Melinda Gates Foundation.

The two main aims of the meeting were to build consensus and political commitment globally and in countries with high levels of M/XDR-TB, and to act immediately to scale up the prevention and management of drug resistant tuberculosis. This will include developing five year national strategic plans, embedded within national TB and health sector plans.

The Call for Action, endorsed on the first day, recognizes the serious threat that this type of TB poses to people living with HIV and draws attention to the actions required to scale-up M/XDR-TB prevention, control and care. Countries are asked to identify the groups most vulnerable to, and at risk of, drug resistant TB and its impact, including people living with the virus, drug users, prisoners, migrant populations and other marginalized groups and to ensure that services to prevent and treat M/XDR-TB are targeted to meet their needs.

Among the recommendations was a call for governments and partners to strengthen efforts to mobilize more funding to finance care and control of the diseases and increase investments in the research and development of new TB diagnostics, medicines and vaccines effective in people living with HIV.

Drug resistant TB and HIV

The 33 million people living with HIV around the world are especially vulnerable to the impact of M/XDR-TB, a drug-resistant form of tuberculosis. They are at increased risk of contracting such types of TB and experiencing serious side effects and drug interactions when second-line drugs are taken with antiretroviral therapy. They are also at much higher risk of dying if affected by M/XDR-TB.

During a session chaired by UNAIDS Country Director for China, Dr Bernhard Schwartländer, the meeting discussed in detail how to strengthen TB/HIV collaboration. Participants agreed that the HIV community has to take greater responsibility for preventing, diagnosing and treating TB among people living with HIV. Michel Sidibe, Executive Director of UNAIDS, has recently stressed UNAIDS commitment and has made ‘stopping people living with HIV from dying of TB’ an organizational priority.

In line with this, Dr Brad Hersh of the WHO HIV/AIDS department stressed the need for TB and HIV programmes to work more closely together to gain efficiencies in these times of economic crisis. Better TB/HIV collaboration has the additional advantage of helping to overcome common health system barriers to successful programme implementation such as laboratory strengthening, quality assured drug supplies, and monitoring and evaluation.

Cindy Kelemi from the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) urged participants to ensure that investment in HIV prevention, treatment and care was not cut as a result of the economic downturn as this would worsen the epidemic of drug resistant TB.

Affected communities are a highly valuable resource in the response and should be engaged in the planning, implementation and monitoring of activities to control and treat M/XDR-TB. Such a participatory approach is also critical in addressing the rising stigma and discrimination around TB, and to further protect the human rights of individuals affected by the disease. This need for community involvement and inclusion of people affected by TB was highlighted by South Africa’s Minister of Health, Ms Barbara Hogan.

More information about the meeting and the Call for Action can be accessed at http://www.who.int/tb_beijingmeeting/en/index.html  

Note: Multi-drug resistant TB (MDR-TB) is tuberculosis that is resistant to at least Rifampicin and Isoniazid, the two most powerful anti-tuberculosis drugs. Extensively drug- resistant TB (XDR-TB) is MDR-TB that is also resistant to at least two out of the three classes of second line TB medicines.