A Double Whammy for Africa: Extensively Drug Resistant TB (XDR-TB) and HIV/AIDS

October 19, 2006

While HIV strips our immune systems and destroys our innate ability to fight diseases, yet another pathogen is emerging the winner, and this time against the very drugs that are used to treat it. Microscopic TB bacilli have maneuvered their way through poorly managed TB treatment programs and have emerged as extensively drug resistant TB or XDR-TB, not just in Africa but also in eastern Europe, western Asia, and South Korea. What’s worse is when you put these two together, it’s a double whammy for countries where HIV/AIDS is already afflicting millions, as Reuters reports:

Highly drug-resistant tuberculosis could become a major killer in AIDS-hit parts of Africa where governments have been slow to roll out TB control programmes, the World Health Organization said on Tuesday.

It’s not just about the speed with which TB control programs have been rolled out in Africa, but also the quality of care and management of the disease through the health system. “Drug resistance to tuberculosis results largely from poorly managed care and control of the disease. Poor prescribing practices, low drug quality (or erratic supply), and suboptimal adherence can all contribute to this,” as reported in a recent BMJ editorial. The bad news is that time is of essence and XDR-TB is resistant to all available drugs, with no new TB drugs on the horizon, almost guaranteeing the double whammy effect in Africa. The good news is that there is a solution (at least in theory!), albeit not easy or inexpensive: one can improve provider capacity to prescribe drugs correctly; improve the quality and supply of drugs; and to some extent improve adherence for TB and HIV/AIDS treatment programs in order to prevent new cases of XDR-TB.

Odd as this may sound, this is an opportunity for all concerned — donors, governments and health providers — to move from vertical disease control programming to more integrated health care service delivery, at the very least for HIV/AIDS and other infectious diseases. Money is where the solution starts but doesn’t end. So, while it is excellent news that “representatives from the Global Fund to Fight AIDS, Tuberculosis and Malaria have agreed to shift existing funds to combat XDR-TB and the U.S.-backed PEPFAR is considering a similar request,” the real challenge is in the implementation.

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1. Dr.Jeram Parmar Says:
   December 13th, 2006 at 2:49 am

   We should learn the lesson of mismanaged program of RNTCP to creat MDR and XDR cases, if we do not take strict step to curb different regimens being practiced in first line of ART, then we will have more cases of drug resistance of first line of drugs used in ART. Today we have 3% drug resistance cases in India nearly 1800, which require second line of drugs costing INR 8000 per MONTH – which is very very expensive. Mumbai alone practicing 85 kinds of different regimens in RNTCP which should not be the case in ART, if proper capacity building is not being done of practicing physician.

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