On February 27, the House Foreign Affairs Subcommittee on Africa and Global Health held a hearing on the threat of drug-resistant tuberculosis (TB), “Multidrug-Resistant Tuberculosis: Assessing the U.S. Response to an Emerging Global Threat.” Non-drug-resistant TB can be treated with six to nine months of “first-line drugs,” which cure 95 percent of cases and cost about $20. Multidrug-resistant (MDR) TB, however, requires 18 to 24 months of treatment with less-effective “second-line drugs” that cost thousands of dollars. Extensively drug-resistant (XDR) TB is a highly lethal form of MDR TB that is resistant to three of the six classes of second-line drugs.
“MDR-TB is on the rise, especially in Eastern Europe,” said Chair Donald Payne (D-NJ). “In four countries in the region, the incidence of MDR-TB was 15 percent or higher among new TB cases. In Estonia, MDR-TB represented 13.3 percent of new infections. An astonishing 24 percent of those MDR-TB infections were the deadly XDR strain…Low- and middle-income countries do not have the resources to treat drug-resistant TB. That is why it is imperative to expand control programs for regular TB.” He noted that the President’s Emergency Plan for AIDS Relief (PEPFAR) reauthorization bill approved February 27 by the Foreign Affairs Committee provides $4 billion over five years for TB treatment (see The Source, 02/29/08).
“The vast majority of those who die from TB 98 percent live in the developing world, and are from the poorest and most marginalized sectors of society,” said Ranking Member Chris Smith (R-NJ). “TB is particularly pernicious in that it targets young adults who are just starting to form their families and who are the producers and sustainers of their societies. The emergence in recent years of drug-resistant TB has raised the specter of higher death rates, more children who will lose their parents, and communities that will fall deeper into poverty and despair.” He continued, “It is important to note that no region indeed no country, including our own is immune from the effects of tuberculosis. We should all be alarmed that strains that are resistant to a single drug have been documented in every country surveyed by the World Health Organization. Given the ease with which TB can be spread, TB is truly a disease without borders, and it is in our national as well as humanitarian interest to seek its eradication.”
U.S. Global AIDS Coordinator Ambassador Mark Dybul testified about PEPFAR’s support for TB-related activities worldwide: “TB is the number one killer of people living with HIV,” he said, “which is why PEPFAR is leading a unified U.S. government global response to fully integrate HIV and TB services at the country level and build the capacity, particularly in Africa, to detect and treat MDR- and XDR-TB. Our goal is to ensure that people who are infected with HIV receive the best treatment and care possible, in order to reduce their risk of contracting or developing TB in the first place.”
He added that treating TB in HIV patients can reduce the development of drug resistance. “One study reported an 80 percent reduction in the incidence of TB among HIV-positive people who are on anti-retroviral treatment, as compared to those who are not receiving anti-retroviral therapy. Thus, in a country where 60 percent of all TB patients also have HIV, if all those who needed antiretroviral therapy received it, it is possible that overall TB rates could drop by as much as 50 percent.” PEPFAR supported care for more than 367,000 people infected with both HIV and TB by the end of September 2007, and will devote $150 million to HIV/TB activities in FY2008. “Unfortunately, by the end of 2005, only 10 percent of all TB patients throughout the African region had been tested for HIV,” he said. However, with the World Health Organization, PEPFAR is increasing the number of TB patients tested for HIV in some African nations.
Dr. Kent Hill, assistant administrator for global health at the U.S. Agency for International Development (USAID), said, “TB kills about 1.6 million people each year, and each year, nine million people develop TB. With HIV/AIDS claiming over 2 million lives each year, and malaria killing more than 1 million, TB is one of the three leading causes of deaths worldwide due to infectious diseases…USAID’s first priority is building strong TB programs to prevent future MDR cases the most important action to stop the spread of MDR and XDR.” From 2000 to 2007, USAID provided almost $600 million for TB programs, in addition to PEPFAR funds.
Dr. Hill cited specific examples of such programs, including investigating an outbreak of XDR-TB in South Africa and improving the care of patients there; enhancing regional laboratory capacity in eastern, western, and southern Africa; and developing regional training courses on MDR- and XDR-TB management in affected nations. “While the majority of our effort will focus on the country level, USAID will fund critical global and regional activities,” Dr. Hill said. “These activities include providing technical support for two or three supranational reference laboratories for MDR/XDR referral in Africa, Asia, and Eurasia where they are desperately needed.” He also said USAID would help drug manufacturers produce quality drugs and spend up to 10 percent of its funding on research into the most effective treatments for MDR-TB.
Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, also testified.
