Atlantic examines drug-resistant TB control worldwide

The Atlantic examines the emergence of drug-resistant strains of tuberculosis around the world, with a look at the situation in South Africa. "[T]he resurgence of tuberculosis is not limited to South Africa. India and China have the largest numbers of tuberculosis cases, and multi-drug-resistant tuberculosis (MDR-TB) has been found in nearly every country, with XDR [extensively drug resistant]-TB in at least 57 countries," according to the article.

Treatment for drug-resistant strains of TB can last "up to two years and is 200 to 1,000 times more expensive than regular TB drugs," according to the Atlantic. "Even with treatment, multi-drug-resistant tuberculosis kills 30 percent of those infected, while XDR-TB kills roughly 60 percent. Unless the world gets ahead of the epidemic, drug-resistant forms of tuberculosis may not only kill hundreds of thousands, but also render moot global efforts to roll out HIV/AIDS antiretrovirals," the magazine writes.

The article also reports on the efficacy of DOTS, which "calls for 'directly observed therapy,' meaning that a patient must be observed taking medication each day by a health worker … Designed to ensure that people complete their treatment regimen, the program - when it is properly implemented - works very well at both curing patients and preventing the rise of drug resistance." According to Martie van der Walt, acting director of the TB-epidemiology group of South Africa's Medical Research Council, "It's been realized that under perfect conditions, DOTS works, but not really in real-life circumstances."

Though there are some experimental drugs for the first time in 40 years, "they will not be available for at least two years, and they won't necessarily solve the current problems," the magazine reports. Mario Raviglione, director of the WHO's Stop TB Department, said new drugs need to be protected from misuse so they are not lost to resistance (Shelburne, Jan./Feb., 2010). The article was funded by a Kaiser Family Foundation Mini Fellowship.