UNITAID investments in better testing for multidrug-resistant tuberculosis (MDR-TB) have led to a dramatic increase in cases detected, but a pressing issue remains – treatment of  MDR-TB is extremely difficult and expensive.

Only 50% of those who endure the two years of gruelling treatment are cured, and until better medicines are introduced, this highly-contagious diseases will remain a dangerous global threat.

World TB Day this year is focused on the three million people who are infected with TB and “missed” by health systems. Through UNITAID-funded projects implemented by the World Health Organization (WHO) and the Stop TB Partnership, more patients are being identified in high-burden countries. These initiatives have scaled up lab-based services and introduced new rapid technologies which shorten the time to diagnose drug-resistant strains of TB from weeks to only a few hours.  UNITAID has made grants to the EXPAND-TB project which is providing state-of-the-art testing facilities to 100 labs in 27 high burden countries with 40% of the problem, and through its TBXpert project which has brought 220 state-of-the-art GeneXpert machines to 21 countries and a 40% price reduction for the test cartridges, for 145 countries.

“The improvements in testing are encouraging although we need to do better as access to MDR-TB testing is still very low, at around 20%” said Philippe Duneton, Executive Director ai UNITAID. “But the challenge is also to have simpler, shorter, more affordable, drug regimens again MDR-TB.”

Some encouraging signs have started to emerge. Just over a year ago, the US Food and Drug Administration (FDA) approved the first new TB medicine in over 40 years, last year the European Medicines Agency (EMA) granted temporary approval of a second MDR-TB drug, and new shorter regimens, including one which lasts only nine months, are showing great potential.  With more MDR-TB patients being identified through improved testing, UNITAID’s TB Medicines Landscape report highlights the growing challenge of how to ensure that these new medicines are widely available at affordable prices to improve treatment success rates.

Medicines for the 500,000 annual paediatric total TB cases also remains a particular issue, with none currently available which meet WHO guidelines.  UNITAID is working with the TB Alliance to develop adapted formulations and make them available as quickly as possible.

One of the main problems for TB lies in the market for treatments.  It remains small and fragmented with upwards of forty different regimens being ordered by a multitude of different purchasers.  This presents a situation with few incentives to manufacturers to invest and innovate for new medicines, where demand is difficult to pool in order to negotiate price reductions, and where forecasting to plan production and avoid product shortages is hard to do.  UNITAID’s Strategic Rotating Stockpile is providing one immediate solution for MDR-TB medicines in particular:  a supply of drugs is constantly available for quick access by any country facing stock outs.  This helps prevent treatment interruptions for patients, particularly important for the MDR strains of the disease.

A TB Market Forum held by UNITAID in 2013 identified four areas for future investment for improving access to TB medicines: finding simpler treatments, improving forecasting and procurement, stabilising production, and developing more strategic coordination amongst purchasers.  A simplified TB treatment market will allow for better and more affordable medicines and therefore greatly transform the lives of those still affected by the disease.

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