Drug-resistant tuberculosis (DR-TB)
WHO/Maxim Dondyuk
DR-TB is a key driver of the TB epidemic in the WHO European Region and one of the reasons that TB remains a major public health threat. Increased resistance to TB drugs particularly affects eastern European and central Asian countries.
The improvements achieved in treatment success in the Region are insufficient to eliminate TB by 2030 and reach the End TB and Sustainable Development Goal targets. If the current situation persists, the majority of new TB patients could be suffering from drug-resistant forms of the disease in a generation’s time. To address this challenge, the collaboration between health and other sectors should be increased; current tools and guidelines, such as rapid molecular tests and the 2019 WHO guidelines for treatment of DR-TB, should be implemented more systematically; and a people-centred approach to care should be adopted as a matter of priority.
What is DR-TB?
In many cases, TB can be cured with 6 months of antibiotic therapy, if properly diagnosed and treated. Incomplete or inadequate treatment can lead to the development of drug resistance, meaning forms of TB that do not respond to 1 or more antibiotics.
Multidrug-resistant TB (MDR-TB) is resistant to 2 of the most potent anti-TB drugs, isoniazid and rifampicin. Its treatment is not only more expensive, but also takes much longer. Today, only half of MDR-TB patients are treated successfully; the other half are at high risk of either not surviving or continuing to transmit the disease. The 2019 WHO guidelines for MDR-TB treatment recommend a shortened oral treatment that reduces side effects and facilitates therapy adherence. The guidelines also urge countries to scale up the introduction of new treatment regimens and new drugs, including the most efficient ones like bedaquiline.
Extensively drug-resistant TB (XDR-TB) is resistant to the main first- and second-line drugs, making curative treatment particularly challenging.
DR-TB in the WHO European Region
The eastern part of the WHO European Region has become the world’s DR-TB hot spot. Of the world’s 30 countries with the highest burden of MDR-TB, 9 are within the Region: Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Ukraine and Uzbekistan.
- Improving detection and diagnosis of DR-TB is essential
- People-centred care helps patients to properly follow treatment
- Research on DR-TB is a priority
- The expert group on drug-resistant tuberculosis research
Improving detection and diagnosis of DR-TB is essential
Fast and accurate diagnosis of TB, along with appropriate treatment strategies, is essential to control and prevent transmission. National capacity to rapidly detect DR-TB is the basis for better diagnoses.
WHO/Europe supports countries in the European Region to improve national capacity to rapidly detect DR-TB through the European Laboratory Initiative (ELI), hosted by the WHO Regional Office for Europe. ELI is an independent advisory and support group active in the field of TB laboratory services, which as of 2018 has expanded its scope to cover HIV and viral hepatitis.
People-centred care helps patients to properly follow treatment
Adherence to treatment is important for all TB patients, but is crucial for DR-TB patients whose therapy can last up to 24 months. Challenges include side effects, costs of medication (if not covered by the public health system) and insufficient understanding of the need to continue treatment, even in cases of a rapid improvement in symptoms. In addition, the stigma or discrimination felt by TB patients is often a barrier to therapy compliance.
A people-centred approach makes care more accessible to patients and limits hospitalization to particularly complex cases. Civil society organizations play an important role in ensuring that TB care is people-centred by providing psychosocial support to patients and their families, including support to patients in completing their treatment. They also help by creating and maintaining public awareness of TB, reducing stigma and strengthening community involvement in treatment and care.
Research on DR-TB is a priority
Research into new vaccines, diagnostics, medicines and treatment regimens for DR-TB, as well as operational research, are regional and global priorities. They are central to the targets set out in the Tuberculosis Action Plan for the WHO European Region 2016–2020 and are at the heart of the ambitious political declaration that was signed at the United Nations General Assembly High-level Meeting on TB, which took place in New York in September 2018.
As part of the European Tuberculosis Research Initiative (ERI-TB), WHO/Europe has facilitated the creation of an expert group to support countries in scaling-up their research specific to DR-TB. The group is composed of experts and stakeholders in the field, including clinicians, public health experts, academics, and representatives of civil society organizations and patient groups.
The group provides guidance to countries on performing operational research on DR-TB treatment, particularly on the implementation of the 2019 WHO guidelines on DR-TB management. It also helps them address country-specific DR-TB research priorities and will develop a template roadmap to build country capacity for TB research.
The expert group on drug-resistant tuberculosis research
WHO/Europe facilitated the creation of an expert group on drug-resistant tuberculosis (DR-TB) to support Member States in the European Region in improving their research on DR-TB treatment. The group, part of the European Tuberculosis Research Initiative (ERI-TB), is comprised of experts and stakeholders in the field of DR-TB, including clinicians, academics, public health experts, and civil society and patient group representatives from across the Region.
Research on new vaccines, diagnostics, medicines and treatment regimens plays a key role in achieving the targets set in the Tuberculosis Action Plan for the WHO European Region 2016–2020, and is both a global and regional priority. In particular, clinical and operational research on shorter and more effective treatment regimens for DR-TB is critical to end TB in the Region.
In 2019–2020, the expert group is focusing on:
- providing guidance to Member States on performing operational research on DR-TB treatment when implementing the 2019 WHO guidelines on DR-TB management;
- providing guidance to Member States on how to address country-specific DR-TB research priorities;
- supporting countries in translating international recommendations on DR-TB treatment into national TB programme documents and tools.
The European Tuberculosis Research Initiative (ERI-TB)
