MDR-TB: a fight we cannot afford to lose! Alexander Golubkov, MD, MPH Senior TB Technical Advisor

Global burden of TB in million incident cases of TB 1.3 million people died from the disease –940,000 deaths among people who were HIV-negative –320,000 among people who were HIV-positive –170,000 death from MDR-TB 410,000 women died from TB (250,000 among HIV-negative women and 160,000 among HIV- positive women, an estimated numbers). 74,000 TB deaths among HIV- negative children 2

What is MDR-TB? Multi-drug resistant tuberculosis (MDR-TB) is a form of TB, when Mycobacteria is resistant to main anti-TB drugs: –Isoniazid and Rifampicin MDR-TB is treated with at least 4 medications, but usually 5-7 drugs Duration of MDR-TB is between 18 – 24 months Patient is getting injections for 6-8 months and oral meds daily, under the direct observation $10,000 – is a minimum cost for 1 case of MDR-TB patient –It’s about $250 to treat sensitive TB 3 A MDR/XDR-TB patient in the Philippines receives trea A MDR TB patient in the Philippines receives treatment A MDR TB patient in the Philippines receives treatment

Percentage of new TB cases with MDR-TB 4 Data: WHO Global TB report 2013

Percentage of previously treated TB cases with MDR-TB 5 Data: WHO Global TB report 2013

Trends in MDR-TB estimation and notification 6

7 Do we know how many prevalent MDR-TB cases in the world?

Gaps in MDR-TB detection 8

Gaps in DR-TB detection Proportion of DST coverage among new cases 2.0%4.0% 5.1% (3.9% in HBC) Proportion of DST coverage among previously treated cases 4.7%6.0% 8.7% (7.7% in HBC) Prevalence of MDR-TB among new cases 3.1%3.7%3.6% Prevalence of MDR-TB among retreatment cases 19.0%20.0%20.2% 9 WHO target is 20% WHO target is 100%

Why are we behind? Countries need to have strong labs to diagnose MDR-TB; however GeneXpert is helping is to screen patients; Countries need to have facilities, staff and drugs to enroll patients on treatment; Programs need to keep patients adherent to a very long and unpleasant treatment…; 10 Photos: William Wells

Treatment outcomes for patients diagnosed with MDR-TB. 2007–2010 cohorts. 11 Data: WHO Global TB report 2013

Treatment outcomes for patients diagnosed with MDR-TB. 2007–2010 cohorts. By Regions 12 Data: WHO Global TB report 2013

Monitoring time trends in % of MDR in new TB cases Data: WHO report

What is USAID doing to control MDR-TB? USAID has a target to support diagnosis and treatment of 57,200 MDR-TB cases/year USAID provides technical assistance to high burden countries to develop National Response Plans USAID helps national TB Programs to detect TB cases through laboratory support and GeneXpert procurement USAID supports country programs to improve quality of care provided USAID helps counties to leverage donor funds for TB and MDR-TB through assistance and collaboration 14

What should the international community do to stop MDR-TB epidemic? Have bold and inspiring VISION to eliminate TB and MDR-TB Focus on achieving results through partnership and collaboration Be accountable for progress made and resources used Include children, women and vulnerable populations in every TB program Build sustainable systems and promote countries ownership Be ambitious! 15

Next Session Room Numbers: Please fill out an evaluation by going to this session’s page on your mobile app OR by filling out a paper evaluation in the back of the room. Thank you! Integration of Family Planning Services into MNCH Programming in Liberia301 The Realities of Integration: NCDs and TB in Ethiopia (Continued)302 Integrating Family Planning with Obstetric Fistula Services: Achieving Reproductive Intentions307 Operational Research Training in the 21st Century308 Constant Contact: Reinforcing Provider Training with Mobile Messages and Supervision in Ghana (Continued)310 Indoor Residual Spraying: A Weapon in the Fight Against Malaria311 Increasing District Level, Evidence-Based Decision Making in Cote d'Ivoire405 Making Every Life Count: Strengthening Civil Registration-Vital Statistics Systems407 How Strengthening Medicines Regulatory Authorities Can Increase Access to Medicines (Continued)413 Child TB: No More Crying, No More Dying?414 Creating the Next Condom: TPPs for Next Generation MPTsBetts Theatre Sustainable Health Gain from Smart Governance of Hospitals and Health Systems Continental Ballroom Gender, Medicines, and the Road to Equity #AreWeThereYet? Grand Ballroom