Containing Drug-Resistant Bacteria is a Global Challenge
How USAID helps countries in Eastern Europe tackle multidrug-resistant tuberculosis
TB — DYK?
Did you know tuberculosis (TB) kills more people than any other infectious disease?
While this disease draws less attention than HIV or malaria, TB kills more people annually than either of those diseases combined.
How? The infection is airborne and can be spread when someone with the disease sneezes or coughs. People are especially vulnerable in crowded settings with poor air circulation, such as prisons, hospitals without adequate infection control measures, and poorly ventilated buildings.
TB can be cured — so why is it still a problem?
While it’s true that most TB cases can be treated and cured, the reality is that it’s not that simple. Treatment for drug-sensitive TB requires a six- to nine-month course of four drugs, and most patients experience difficult side effects. Without support and supervision from a trained health worker or volunteer, many patients struggle to successfully complete their treatment. The result? Development of drug-resistant bacteria.
Drug-resistance emerges when patients start and — after a short period — stop taking their TB medicines, allowing the bacteria to become resistant to one or more of the drugs.
Multidrug-resistant tuberculosis (MDR-TB) can spread from one person to another. It is treatable and curable by using stronger drugs, but we have few second-line treatment options. When bacteria becomes resistant to those drugs, as well, we face extensively drug-resistant TB (XDR-TB). XDR-TB patients have even fewer treatment options than MDR-TB and can remain infectious for longer periods of time.
TB and MDR-TB adhere to no boundaries and spread easily, so it’s critical for both national and global security that it be contained.
Why focus on Eastern Europe? Aren’t TB rates higher in other regions?
Yes, TB incidence in Eastern Europe is among the lowest in the world, but the region’s burden of MDR-TB is the highest. Nine of the 30 countries struggling with the highest burden of MDR-TB are found in the region.
How did this happen? The high rates of MDR-TB in Eastern Europe point to deeper issues within the region’s health systems — heavy reliance on hospitalizations and weak outpatient systems of care, with insufficient patient support. Stigma around the disease further complicates the situation, as people often do not go to the doctor early enough to start effective treatment, leading to lower success rates for treating MDR-TB.
The over-hospitalization for illnesses stems from the region’s Soviet past; many countries have not yet properly decentralized health services to develop stronger primary level care, or updated training and treatment standards to meet international guidelines. Until these systemic issues are addressed in this region, TB will continue to pose a serious public health challenge.
Our approach: a focus on health systems
Our programs help ensure health care providers correctly diagnose and treat TB and MDR-TB, provide a support system to ensure patients complete lengthy treatments, and make healthcare accessible so that patients come for treatment early.
Our program strengthens each country’s health system to respond to TB — rather than set up parallel systems or services — to work toward a day when USAID assistance is no longer needed.
While we still have a long way to go, our partnerships have made important progress. Last year, our support helped introduce a shorter standardized treatment regimen for some MDR-TB patients that takes roughly half the time as conventional treatment.
We’ve also helped countries better diagnose TB. In 2011, only one-third of MDR-TB cases in the region were diagnosed, and in many cases, only after months of hospitalization and failed treatment. Since then, MDR-TB detection in Eastern Europe has increased from 34 to 52 percent.
In the past, many health facilities kept TB and MDR-TB patients together in hospital wards and waiting rooms without maintaining adequate infection control. Today, modern infection control practices are in place — the installation and maintenance of sound ventilation systems, air filters and other biosafety equipment — and are leading to steady declines of TB cases.
And together, we’ve helped national TB programs better predict their need for drugs and diagnostic equipment. In 2011, four of our six partner countries had run out of essential TB drugs; since 2015, all six countries have been well stocked.
Through this work, USAID hopes to end the burden of MDR-TB in the region and help countries advance toward sustaining their own programs. By helping Eastern Europe contain the spread of this disease, we help protect the global population.
Read more information on TB in the region.
About the Authors
Bhavna Patel is a health advisor in USAID’s Bureau for Europe and Eurasia working on strengthening health systems in the region. Leisha McParland is a communications specialist for USAID’s Bureau for Europe and Eurasia. Follow their work @USAIDEurope.