Overcoming drug-resistant tuberculosis

Tuberculosis (TB) control is threatened by multidrug-resistant (MDR) and extensively drug- resistant (XDR) strains. While new diagnostic tools enable rapid detection of TB and MDR-TB, treatment programmes are hampered by limited capacity for M/XDR care and insufficient supply of quality assured second-line drugs. Additional efforts required include a focus on preventing transmission of resistant strains, improving diagnosis and management of latent infection, childhood disease and care delivery to vulnerable populations, and those affected by natural disasters or conflict. Strong TB programmes ensuring equity of access to quality diagnosis and treatment compliance are central to control efforts, whereas weak and poorly funded programmes contribute to selection and the spread of drug resistance. The current financial crisis in particular is affecting the Global Fund for AIDS, Tuberculosis and Malaria and threatens to limit the programme's resources. Unless alternative funding (international as well as domestic) is identified urgently there exists the risk of reversing gains accrued in controlling these three diseases, including facing the prospect of an increasing burden of drug-resistant tuberculosis.