Multidrug-resistant tuberculosis (MDR-TB) programmes can be successful, but only with a massive increase in research to equip healthcare workers with the appropriate tools, write Frank G. J. Cobelens and colleagues in PLoS Medicine.
Drug-resistant TB is a man-made problem, resulting from weak TB control measures such as using inadequate drugs and regimens, poor case management and allowing preventable transmission.
Pilot MDR-TB programmes in five poor countries have yielded treatment success rates of 59–83 per cent, showing that such programmes are feasible, say the authors.
But there are many challenges in scaling up from pilot projects to TB control programmes. Both biological and clinical issues need to be addressed first.
Drug susceptibility testing, alongside the development of laboratory support, needs to be improved to give patients the correct drugs. Better second-line drugs — some are already in the pipeline — are needed, and treatment strategies should be tested and standardised in large clinical trials. Epidemiological studies are also required to identify areas of high risk.
"Strategies therefore need to be developed that maximise treatment adherence in a sustainable way, and factors that affect adherence need to be studied, including the role of adverse events and levels of patient support," the authors say.