Tackling drug-resistant tuberculosis: we need a critical synergy of product and process innovations

• Published in: The international journal of tuberculosis and lung disease Vol. 23; no. 7; pp. 774 - 782
• Main Authors: Talbot, E. A., Pai, M.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-07-2019; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Access; Antibiotics, Antitubercular - pharmacology; Antibiotics, Antitubercular - therapeutic use; Comorbidity; Diagnosis; Diagnostic systems; Epidemics; Equity; Global Health; Health Services Accessibility; Human resources; Humans; Innovations; Microbial Sensitivity Tests; Multidrug resistance; Multidrug resistant organisms; Multidrug-Resistant; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Scaling; Tuberculosis; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - prevention & control; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - prevention & control
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0715

The End TB Strategy diagnostic pillar calls for access to high-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). The recommended diagnostic technologies available in low and middle-income, high-burden countries for multidrug-resistant tuberculosis
(MDR-TB) are essentially limited to Xpert® MTB/RIF and MTB/RIF Ultra assays, culture DST and the line-probe assays. The primary reasons for slow scale-up are insufficient political will, and therefore, insufficient funding for qualified human resources, and safe laboratory and
health system infrastructure. Innovative approaches to enable the private health sector to provide high-quality diagnosis are also needed. The Essential Diagnostics List provides impetus and a standard benchmark for the rational implementation of MDR-TB diagnostics, but the epidemic will ultimately
only be favorably impacted by complete end-to-end solutions to patients that address the complete cascade of care, including patient-centered diagnosis and treatment of TB and MDR-TB, management of comorbidities and social protection. By scaling up access to the currently available diagnostics,
we lay the groundwork for future innovations for rapid accurate diagnosis of MDR-TB, which in turn will bring us closer to meeting the targets in the End TB Strategy.