Drugs for extensively resistant Tuberculosis arrive Nigeria

•Treatment of XDR-TB receives boost

Strong indications have emerged showing that treatment of Tuberculosis (TB) patients that are already resistant to first and second-line drugs will be scaled up as Nigerian Institute of Medical Research (NIMR) has announced that the first batch of drugs for Extensively Drug-Resistant Tuberculosis (XDR-TB) has arrived in the country. The drugs were provided by the World Health Organisation (WHO).

Statistics from the WHO show that an estimated nine million new cases of TB occur globally, out of which three million cases are missed, either not diagnosed, not treated or diagnosed but not registered by the National TB programmes (NTPs). Researchers at NIMR are worried that Nigeria remains among 11 high TB burden countries that contribute 15 per cent of the three million missed cases of TB, globally. Decrying that it is unacceptable that Nigeria ranks third among the 11 countries, they said despite control efforts by the Federal Government, Nigeria does not meet any of the Millennium Development Goals, MDG 3 targets in reducing TB incidence, prevalence and mortality rates. 

They further lamented that the burden of TB in Nigeria was further made worse by challenges of HIV co-infection, drug-resistant TB and TB among children, adding; “We are even going beyond multi drug resistance TB cases as we are now having cases of Extremely Drug Resistant TB in Nigeria.” Head of the NIMR TB research group, Prof. Oni Idigbe, confirmed on Tuesday, that the first batch of drugs for XDR-TB has arrived in the country. Idigbe who made the confirmation in an interview had earlier given hint that the drug would soon arrive the country during the commemoration of the World Tuberculosis Day 2015, by the institute. He stressed that Nigeria had made steps to go beyond the Multi-Drugs Resistant TB (MDR-TB) and into the XDR-TB for effective treatment intervention. 

According to him, “Nigeria is on top of TB cases and we have donor partners that have been supporting us with drugs for MDR-TB. I just came out of meeting that has started ordering drugs for XDR-TB. Government is doing the very much they can do but 80 to 90 per cent of our support now are donor driven,” he said. Idigbe had explained that while first-line drugs are used for treatable TB cases, second-line drugs apply to cases that have developed resistance (Multi-Drug Resistant TB). But where there is resistance to MDR-TB drugs, the anti-XDR-TB is required.   He added that the world had in fact gone beyond anti-XDR-TB drug. The NIMR TB research group Head said: “TB organism in a patient can become resistant to treatment drugs if the patient fails to use the prescribed drugs religiously or if the healthcare giver does not prescribe the exact number of approved combination. “Drug resistance is very much with us. 

By 2013/14, the WHO has recorded about 480,000 cases of Multi-Drug Resistant TB (MDR-TB). MDR-TB is also in Nigeria and we are concerned because those that have contacted it can no longer be treated with the first-line anti-TB drugs, which are quite cheap and less toxic. “They will now be treated with the second-line drugs. These are very expensive, very toxic and take longer period of treatment. You need between one and one-year plus for treatment, whereas it is six months in the case of susceptible TB. So, MDR-TB is a growing problem,” Idigbe noted. Continuing, he said, Nigeria had been able to come up with a national policy to diagnose and treat MDR-TB at the 14 wards dedicated to MDR-TB treatment across the 36 states. Because of the increasing number of cases now seen, Nigeria has also gone beyond the wards into adopting community-based management of MDR-TBs. 

He advised that all hands must be on deck to collectively tackle TB cases, often predominant in communities, by creating awareness and going for treatment in cases of persistent cough. Diagnosis and treatment of TB at the DOT centres are free. Notwithstanding several efforts to tackle the TB problem globally, Idigbe said achieving zero infection would be a tall order before 2025 or 2030. “This is so, because with all the money put into TB, we know we have diagnostic tools, drugs that can cure, structures for protective management, WHO still needs a minimum of $200b to be able to effectively carry out all the strategies on ground for TB.” The Director-General, NIMR, Prof. Innocent Ujah, said the death toll from the disease is still unacceptably high and efforts to combat it must be accelerated if the global targets, set within the context of the MDGs, are to be met. Ujah who also spoke during the commemoration of World TB Day, listed the ongoing strategies in conducting research on TB said 2015 marks a transition from MDGs to post – 2015 development frame, adding that within the context, the WHO has developed a post – 2015 global TB strategy called “the End TB Strategy”. 
The goal of the strategy is to end the global TB epidemic by 2035 with targets of 95 percent reduction in TB deaths and 90 percent reduction in TB incidence. The strategy also targets a zero catastrophic costs for TB affected families by 2020. NIMR boss emphasised the need to intensify efforts towards reaching those that have been infected but do not have the information on where to access the diagnosis and treatment. Ujah observed that it is important to also intensify outreach efforts in; at-risk communities and slums, screening of HIV infected individuals for TB, capacity building through training and research, adequate laboratory support system, treatment and funding. In his lecture tagged; “Efforts on Tuberculosis Control”, Dr Dan Onwujekwe of the Clinical Sciences Division, NIMR, noted that DOTS is still an assured strategy for TB control and that innovative non –DOTS modifications achieved high acceptance treatment success rate in NIMR as one stop shop facility for HIV/TB management. He noted that health workers managing TB/HIV should assess and factor in individual patient constraints in devising innovative ways of improving TB treatment outcomes. 

“We can reach, treat and cure TB through innovation approaches to improve treatment completion, working in collaboration with community – based organisations,” he added. Chief Research Fellow and Consultant Paediatrician, Dr. Nkiruka David, added that TB is also common among children, but doesn’t come with cough symptoms like it is the case with adults.   “They are often undetected and that is why we must raise awareness. It is treatable within six months, but it has to be properly diagnosed first,” David said. Meanwhile, the WHO is calling for “global solidarity and action” to support a new 20-year strategy, which aims to end the global tuberculosis epidemic. The world health body decried that an estimated 1.5 million people still die of tuberculosis each year. The disease frequently has devastating economic consequences for affected families, reducing their annual income by an average of 50 percent, and aggravating existing inequalities. 

“This is a matter of social justice, fundamental to our goal of universal health coverage. Each and every man, woman or child with TB should have equal, unhindered access to the innovative tools and services they need for rapid diagnosis, treatment and care,” said Dr Margaret Chan, WHO Director-General. Speaking, Dr Margaret Chan, WHO Director-General said 2015 is seen as a critical year for action to adapt and roll out the strategy in diverse country settings. Achieving success for the strategy will require the TB community around the world to work together to leverage alliances and resources.

This story was published in Newswatch Times on April 16,  2015.


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