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[CAPE TOWN] Efforts to control tuberculosis (TB) are out of step with international recommendations and new and promising drugs are not being used, says a new report.
The report by Médecins Sans Frontières (MSF) was presented on 30 October during the 45th Union World Conference on Lung Health in Barcelona, Spain.
The report, based on a survey of TB policies and practices in eight high-burden countries, including three African nations —  Kenya, South Africa and Zimbabwe — identifies critical treatment gaps that must be addressed to help meet the WHO’s post-2015 TB strategy and targets, especially on drug-resistant forms of TB (DR-TB). The other countries are Brazil, India, Myanmar, Russian Federation and Uzbekistan.
“Drug-resistant forms of TB will continue to spread unabated unless a stronger and more concerted effort to scale-up DR-TB services, in step with the implementation of optimal tools, guidelines and policies, is made at the country level,” says the report.

“Countries must increase their efforts to optimise DR-TB care in line with international guidelines and seize the opportunity that new tools offer to strengthen and accelerate the fight against TB.”
Petros Isaakidis, Médecins Sans Frontières (MSF)

The report notes gaps in implementation such as poor access to drug resistance testing, continued use of costly, outmoded models of care and funding shortfalls. Limited access to new drugs is also a hindrance, coupled with a growing number of patients who are diagnosed with DR-TB but left untreated.
MSF is calling for a collaborative response from countries, global health actors and donors to increase treatment at country level to overcome these problems. Industry in particular is signalled out, with MSF revealing that noteworthy DR-TB drugs such as bedaquiline and delamanid are unavailable in all the countries surveyed.
MSF senior operational research fellow Petros Isaakidis, says: “Countries must increase their efforts to optimise DR-TB care in line with international guidelines and seize the opportunity that new tools offer to strengthen and accelerate the fight against TB”.  
Less than one-third of the estimated 480,000 DR-TB patients worldwide are diagnosed, and only one in five receive proper treatment, according to the WHO. In South Africa, more than 15,000 cases have been diagnosed. However, only 42 per cent receive treatment.
One of the biggest impediments to care is the time required for treatment regimens, says Alison Best, advocacy, communication and social mobilisation manager for the Cape Town-based non-profit organisation, TB/HIV Care Association. Therapies for DR-TB can take up to two years to complete.
 “We need trained members of the community who can support patients to adhere to their treatment and navigate the sometimes confusing landscape of the clinic and treatment process,” Best adds.  
According to Best, the MSF report can help put pressure on governments and donors to control the disease by allowing countries to benchmark themselves against others and galvanise them to take actions.
 Link to the MSF report
This article has been produced by SciDev.Net's Sub-Saharan Africa desk.

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