Transcript Research Agenda for DOTS-Plus for MDR-TB

Sources of Limited Access to Treatment
High Cost of Treatment
Lack of Demand
Lack of Pilot Projects
Lack of Policy
Lack of Evidence
Treatment Regimen Costs
Per Patient Drug Cost (USD)
Standard Reference Country Cost (USA)
High Income Country Average Cost
Low Income Country Average Cost
Green Light Committee Cost
60000
50000
40000
30000
20000
10000
0
HR
HRES
HRESZK
Resistance Pattern
Gupta, et al., Science 2001.
Linking Independent Concepts
ACCESS
RATIONAL
USE
GLC
POLICY
Green Light Committee (GLC)
• Releases preferentially-priced, quality-assured
drugs
• Decision process
– application review
• Instructions for Applying to the Green Light Committee for
Access to Second-line Anti-TB Drugs
• Guidelines for Establishing DOTS-Plus Pilot Projects for the
Management of MDR-TB
– site visit
• Continual monitoring of projects
• Technical assistance
Gupta, et al. Trop Med Intl Health, 2001
Changing Global Health Policy
• New guidelines for MDR-TB treatment
• Expanding DOTS framework to include MDR-TB
– HIV, public-private mix
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Improving allocation of financial resources
Increasing new funds for TB control
Scaling up primary health care/capacity building
Bridging equity gap
• No longer whether or not to treat patients, but how to best
treat patients
Similarities between HIV and MDR-TB
• Multidrug regimen given for extended periods
with adverse events
• Disproportionately affects disadvantaged
• Access to drugs
• Drug resistance
• Laboratory requirements
• Lack of standard international policy
• Most experience in resource-wealthy settings