Scaling Up the Programmatic Management of Drug-Resistant TB (PMDT)
The aim of objective 3 is to address the Multidrug-resistant and Extensively Drug-resistant (M/XDR-TB) epidemic in the Western Pacific Region and to offer a framework for further development and refinement of national PMDT plans.
In May 2009, the Sixty-second World Health Assembly adopted resolution WHA62.15 calling for strengthening the prevention and control of drug-resistant tuberculosis. The resolution was inspired by the Beijing Call for Action in response to M/XDR-TB, endorsed at a ministerial meeting in Beijing in April 2009. The resolution urges Member States to achieve universal access to diagnosis and treatment of drug-resistant tuberculosis to save lives and protect communities. This global momentum is reflected by increased funding and technical and managerial support through the Green Light Committee Initiative , the Global Drug Facility and the Global Laboratory Initiative. WHO guidelines on PMDT are regularly updated to provide the evidence base for PMDT.
At the same time, the Western Pacific Region has not seen much progress in preventing the development and transmission of drug-resistant TB. Less than 3000 patients received second-line treatment between 2005 and 2009, covering only a fraction of the estimated number of MDR-TB cases (see graph below). Although most countries with a high burden of MDR-TB have successfully piloted PMDT, the scale up is hampered by the lack of: (a) laboratory networks; (b) qualified human resources; (c) effective linkages with private and hospital sectors; (d) models of care that ensure adherence to long and complicated treatment regimens; (e) quality-assured second-line drugs; and (f) infection control. Overall, there is limited strategic planning of PMDT at all levels.
The following are some fundamental steps to be taken for PMDT scale-up:
- Representative drug-resistance surveillance (DRS) intensified (in compliance with the updated WHO DRS guidelines) to adequately monitor the burden of MDR-TB. It should incorporate HIV testing;
- Mobilize resources for all components of their national M/ XDR-TB response plans, ensuring that all identified MDR-TB suspects and patients have equitable access to quality-assured diagnosis and treatment. This includes national capacity-building and training (e.g. training of trainers);
- Laboratory scale-up plans developed in-line with PMDT scale-up plans to ensure that the capacity to diagnose, treat and procure quality assured MDR-TB drugs is well balanced;
- Invest in operational research to design and implement the upcoming trials that will bring the new drugs needed to facilitate PMDT and control drug-resistant TB.