Promoting Safe and Effective Treatment for Multidrug-resistant Tuberculosis

Among patients identified with pulmonary tuberculosis (TB) in 2011, an estimated 310,000 had multidrug-resistant (MDR)-TB (1). However, less than 20% of these patients were diagnosed and treated for MDR-TB (1). By definition, MDR-TB is resistant to the two most effective TB medicines. Consequently, patients require complex treatment comprised of multiple drugs for up to two years. These medicines are not only more expensive and less effective than the standard treatment for TB, but they are also associated with severe side effects, such as permanent hearing loss.

In an effort to promote optimal treatment for MDR-TB, the USAID-funded Systems for Improved Access to Services and Pharmaceuticals (SIAPS) project sponsored a symposium on Saturday, November 20 titled “Rational Drug Use for MDR-TB: start safe, stay safe, breathe safe.”  TB medicine expert Dr. Jose Caminero and SIAPS Senior Technical Advisor Dr. Archil Salakaia facilitated discussion from a panel of TB specialists on how to design safe and effective MDR-TB treatment regimens. Presenters identified a number of challenges in administering MDR-TB treatment; for example, its long duration and high rates of side effects may prevent patients from completing their full treatment course. If patients stop medicine early, not only does their TB remain uncured but they also risk developing further resistance and spreading TB to others in the community.

To address this challenge and others, the symposium highlighted a number of useful approaches to prevent and manage MDR-TB, such as adherence to standard treatment guidelines, as well as the SIAPS tool “Guidelines for Conducting Drug Resistant Tuberculosis Drug Utilization Reviews”.  At a time when new medicines are under development and treatment recommendations are changing alongside evolving evidence, the symposium served as an important opportunity to discuss resources available to help both providers and patients.

 

Citation:(1) Stop TB Partnership. Stop TB Working Group on MDR-TB. http://www.stoptb.org/wg/mdrtb/keyfacts.asp

Pharmacists, Drug Sellers, and Pharmacy Associations: Key Players in the Fight against TB

While the National Tuberculosis Programs (NTP) of most countries offer free diagnosis and treatment for tuberculosis (TB), many people worldwide first seek care from other providers, such as physicians in the private sector, pharmacists, or informal drug sellers. Partnerships between NTPs and providers in the private sector have long been touted by the World Health Organization (WHO) as a way to increase patient access to timely diagnosis and quality treatment regimens; however, pharmacists and pharmacy associations have only recently been recognized as key players in these partnerships.

On Saturday, November 2 the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program organized a symposium on the involvement of private pharmacists in TB, titled “Engaging pharmacists for TB control: rhetoric or reality?”

The symposium featured country experiences from Tanzania, Pakistan, and India, all of whom have done innovative work building collaborations between private sector pharmacies and the NTP.

The symposium highlighted that while pilot projects have shown the value of engaging pharmacists, additional data is needed about the specific costs and returns that countries can expect when engaging pharmacists, as well as the incentives that are needed to motivate all stakeholders. Public-private mix (PPM) expert Mukund Uplekar facilitated an interactive session and lively discussion that highlighted both the importance of pharmacists in TB as well as the need to understand the local health system when designing interventions.

Emily Delmotte (@edelmott) is a technical associate in the Center for Pharmaceutical Management at MSH.

Covering All the Bases: Ensuring Availability of TB Medicines

When purchasing a medicine from the shelf of a local pharmacy, it’s easy to forget the many miles traveled and challenges overcome to make it available to consumers. This is especially true for tuberculosis medicines, which come from a limited number of manufactures and often have short shelf-lives. Unless countries have accurate information on the number of patients who need treatment at any given time, medicines can expire, with great financial cost, or become stocked out, with great cost to the health of patients.

At the 44th Union World Conference on Lung Health, the Global Drug Facility collaborated with the USAID-funded, MSH-led Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program to address the ways in which countries can ensure patients have access to quality medicines when they are needed.

The full day workshop, titled “Global Drug Facility (GDF): Universal Access to Internationally Quality Assured (IQA) TB Commodities” centered on the tools and techniques National Tuberculosis Programs can use to ensure they maintain adequate stocks of TB medicines. Representatives from the GDF described early experiences from a pilot project titled Early Stock-out Warning System, an approach designed to help countries extract and analyze data to avoid stock outs or expiry of medicines.

The presentation paved the way for the launch of a new SIAPS tool called QuanTB. QuanTB, a free, downloadable tool, is designed to simplify the way in which TB staff forecast and quantify the number of medicines needed. SIAPS staff provided a demonstration of the tool, which allows users to modify items such as treatment regimens, buffer stock, and lead time in order to reflect the local environment.

Through tools such as QuanTB, and approaches like the GDF’s early warning system, the workshop provided participants with concrete ideas about how to guarantee shelves are stocked with quality medicines when patients seek treatment.

Dr. Salakaia speaking at the SIAPS-GDF workshop

Dr. Archil Salakaia, Senior Technical Advisor for SIAPS, moderates the GDF workshop.

Andre Zagorski, Principal Technical Advisor for TB in the SIAPS Program, discusses the GDF workshop with Dr. Mahshid Nasehi, National Manager of the Iran TB & Leprosy Control Programmes

Andre Zagorski, Principal Technical Advisor for TB in the SIAPS Program, discusses the GDF workshop with Dr. Mahshid Nasehi, National Manager of the Iran TB & Leprosy Control Programmes

(from left) SIAPS Senior Technical Advisors Philo Kakanda, Chinwe Owunna, and Salama Mwatawala after the GDF session. Ms. Owunna coordinated the workshop while Ms. Mwatawala presented two sessions.

(from left) SIAPS Senior Technical Advisors Philo Kakanda, Chinwe Owunna, and Salama Mwatawala after the GDF session. Ms. Owunna coordinated the workshop while Ms. Mwatawala presented two sessions.

Emily Delmotte (@edelmott) is a technical associate in the Center for Pharmaceutical Management at MSH.