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Drug-resistant Tuberculosis Control: listening other voices

Posted by plosmedicine on 31 Mar 2009 at 00:01 GMT

Author: Jose Luis Portero
Position: Medical Consultant
Institution: None
Additional Authors: Maria Rubio
Submitted Date: November 09, 2006
Published Date: November 9, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Drug-resistant tuberculosis is mainly a phenomenon caused by physicians, patients, and health care systems through incorrect treatments, non-compliance, and poor delivery of tuberculosis services, respectively. These man-made facts could be avoided with appropriate actions. However, the weakness of health systems in the tuberculosis high-burden countries hampers a successful control.

Public health priorities in poor-resources settings have marginalized tuberculosis cases resistant to first-line treatment. Nevertheless, patients have been claiming their rights to be treated despite their drug resistance pattern. Nowadays, tuberculosis programmes try to address drug resistance issues. However, pilot experiences in low resource settings do not fully answer to the real challenges on the field to scale up second line drug treatments [1].

Governments from high-burden countries must enhance their commitments with their respective communities to provide better health and to alleviate poverty. Regarding drug resistant tuberculosis control these actions include to improve organization and effectiveness in all levels of the tuberculosis programmes to avoid misuse of resources. In addition to that, it is a must to address ignorance about tuberculosis transmission and treatment, social stigma and discrimination. However, the current programme design to control drug resistant tuberculosis underestimates the environment of poverty suffered by the patients. In this sense, it is paradigmatic that one of the obstacles to follow the treatment in the last pilot project published was that the patients were unable to buy symptomatic drugs to relief the second line drug side-effects [2]. Governments, World Health Organization, physicians and technocrats may open their eyes to the reality on the field [3].

Unfortunately, we are far worldwide from a reliable system to fight drug resistant tuberculosis. The complexity and requirements of treating resistant cases generally exceed the average available health care. In the other hand, the current cost of second-line anti-tuberculosis drugs is unbearable for the developing world being a great obstacle to the scaling-up of the treatment. The cost of the drugs and the laboratory supplies is not the appropriate for the developing countries. No significant steps have been taken to put in practice a coordinated system to manage drug resistance in the community. Cost-effectiveness studies do not usually reflect the hidden costs for the patients and the real cost of the interventions in the present conditions. Feasibility measures do not take into account most of the socio-economic barriers on the field.

There is a lack of independent opinions regarding drug-resistant tuberculosis, so Resch et al article is very valuable [4]. Tuberculosis experts are in danger to listen only their own words enclosed in a technocrat circle. It would be desirable to open the control of tuberculosis to the civil society and to listen to other voices.

1. Eva Nathanson, Catharina Lambregts-van Weezenbeek, Michael L. Rich, Rajesh Gupta, Jaime Bayona, et al. (2006) Multidrug-resistant Tuberculosis Management in Resource-limited Settings. Emerg Infect Dis. 2006 Sep; 12(9):1389-97

2. Tupasi TE, Gupta R, Quelapio MID, Orillaza RB, Mira NR, et al. (2006) Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: A cohort study in the Philippines. PLoS Med 3(9): e352. DOI: 10.1371/journal.pmed. 0030352

3. Civil society perspectives on TB Policy in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand. (2006) Public Health Watch. Open Society Institute. www.publichealthwatch.inf...

4. Resch SC, Salomon JA, Murray M, Weinstein MC (2006) Cost-effectiveness of treating multidrug-resistant tuberculosis. PLoS Med 3(7): e241. DOI: 10.1371/journal. pmed.0030241

Competing interests declared: We declare that we have no competing interests