Lack of funding and enforcement leads to drug-resistant TB in developing world
The excessive use and abuse of popular TB therapeutics caused the disease to develop drug-resistance, with both multi-drug-resistant TB and extensively drug-resistant TB. The World Health Organization estimates the occurrence of MDR-TB will account for more than 25 percent of treatment cost worldwide by 2015.
The increasing concern demonstrates a need for attitudes to change when it comes to adhering to disease treatment.
"Healthcare providers typically supervise the first two months of TB therapy, but during the four-month continuation phase patients are expected to self-medicate," Christopher Pace, a GlobalData infectious disease analyst, said. "Failure to adhere to daily treatment often results in the appearance of MDR-TB, which requires up to 20 months of antibiotic treatment. The long-term cost-effectiveness and public health benefits of improved patient compliance would therefore seriously outweigh any short-term obstacles. In developing nations, programs such as the WHO's Directly Observed Treatment, Short-course set standards of care that seek to improve patient compliance and the government's role in TB therapy."
Adhering to TB treatment in the developing world is a complicated matter, according to GlobalData analyst Brad Tebbets.
"Low- and middle-income countries are disproportionately affected by TB, and these countries rely heavily on international donations and public-private partnerships to support their disease treatment and control efforts, with The Global Fund to Fight AIDS, TB, and Malaria providing almost all of this support," Tebbets said. "The WHO reports that these programs will require twice the current investment over the next three years if they are to succeed, and the on-going economic concerns in the U.S. and EU make it unlikely that these countries will increase their contributions."
The treatment of HIV, a frequent counterpart to TB around the world, could inspire the development and correct application of TB therapeutics. According to UNAIDS, uptake for antiretrovirals in sub-Saharan Africa rose 100-fold since the last decade, reaching 6.2 million people in July. In that time, first line treatment dropped from $10,000 annually per person in 2000 to less than $100 today.
"Generic manufacturers enjoy a unique approval process under the U.S. President's Emergency Plan for AIDS Relief, with tentative approval by the FDA aiming for the expedited approval of generic drugs in countries severely burdened by HIV," Charalampos Valmas, a GlobalData infectious disease analyst, said. "The medicines patent pool also works with patent holders that voluntarily contribute their patents to MPP to foster collaboration with generics manufacturers to produce drugs. Leading companies in the antiretrovirals market, such as ViiV Healthcare and Gilead Sciences, serve as contributors to MPP. This allows expanded access to their drugs where they are mostly needed, helping to cut the increase of drug-resistance and mortality."
TB is responsible for more than one million deaths worldwide each year.