Healthy Dose: India Prepares Response to Growing TB Resistance

September 6, 2012

Tuberculosis DOTS programme

India is increasing its efforts to address TB in the wake of the discovery of some cases that are resistant to all current drugs. From the Washington Post:

For the past decade, a nationwide tuberculosis program involving millions of health workers and volunteers made slow but significant progress in battling the disease in India and was hailed as a public health success story. But any sense of complacency was dispelled last December when a doctor in Mumbai, Zarir Udwadia, discovered a strain of the disease that didn’t respond to any of the 12 frontline drugs. He declared a handful of patients at his chest clinic in Mumbai to be suffering from “totally drug-resistant TB.”

Some 130 years after the discovery of the tuberculosis bacteria, and more than 60 years after the discovery of antibiotic treatment, “we have managed by a combination of complacency and incompetence to allow this bacillus to mutate into a virtually untreatable form,” he wrote in the journal of the Asian Pacific Society of Respirology.

His findings made national headlines and won him government condemnation for “spreading panic” and “spoiling the country’s reputation.”

The government, however, recently announced a fourfold increase in the budget to fight tuberculosis in its next five-year plan, the expansion of a nationwide network of costly labs capable of detecting drug-resistant strains of the disease, and the first concerted effort to bring on board India’s poorly regulated private health-care sector.

“The government is taking a very ambitious approach of universal access,” said Ashok Kumar, director of the national TB program. “We aim to detect all TB cases as early as possible and see everyone takes their treatment early and completes it. It needs a lot of effort.”

About 2 million Indians have the disease diagnosed every year, and about 1,000 die of tuberculosis every day.

But the highest mortality rates are found within an estimated 100,000 Indians who suffer from “multi-drug-resistant” strains of the disease, so called because patients do not respond to the two most powerful drugs available.

Months of treatment are needed to eradicate tuberculosis from a patient’s system, and failure to complete the course, or take the right drugs, often allows the bacillus to mutate into drug-resistant strains.

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Global Health and Development Beat

Family Planning – Trials of vaginal rings that protect against HIV were effective in tests with monkeys, says a paper published in the journal Science Translational Medicine.

HIV/AIDS – The GHESKIO AIDS clinic in Haiti is successfully operating following $10 million in repairs following the earthquake.

HIV/AIDS – A new study shows that ARV coverage among people living with HIV in the United States is up by 9 percentage points since 2000.

Malaria – Researchers say they have uncovered a genetic mutation among people from Southeast Asia that protects them against malaria and is similar to sickle cell.

Dengue – Some 40,000 people have been infected by dengue in Vietnam this year, up 35% as compared to the same period last year.

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The Players

UNDP – Namibia’s government should look to partner with the private sector in order to achieve the MGDs, said the UNDP resident representative in Namibia.

UN – Agencies will work together to monitor and track water supply, sanitation and water resources management around the world.

FDA – Announced it will give Johnson & Johnson’s new drug that treats multi-drug resistant TB a priority review.

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Spotlight on PSI

The Swazi Observer covers this week’s Lugotjwa Lusemanti Baby Fair at the Mavuso Trade Centre hosted by PSI/Swaziland.

The event, attended by expectant moms and parents of newborn babies, sought to encourage new moms to circumcise their newborn boys.
The highlight of the event was a fashion show for the expectant moms.
It was also a marvel to watch as the pregnant mothers came decked out and fabulous in their figure hugging LBDs.

Black was a popular colour of choice as it is believed to be slimming and effortlessly sexy.

The women looked fashion forward and confident. After the fabulous moms-to-be strutted their stuff on the ramp, male models walked the ramp topless with babies on each of their arms. Amongst these models was Mr. Swaziland Linda Dlamini, who was a crowd favourite.

The audience learnt a lot during the event. Programme directors Sabelo Dlamini and his wife Nonhlanhla gave way to Futhi Dlamini of PSI Swaziland who educated the audience about the benefits of early circumcision for male babies. “The campaign is basically in favour of the early circumcision of the boy child,” Dlamini said.

She also addressed the guests on the health benefits that come with early circumcision of the boy child. “It is wise to circumcise new born babies as the healing process is quicker than at adulthood. Also, your child is protected from germ-caused infections as proper washing of the male genitals is guaranteed by circumcision. When your son grows up and makes the decision to become sexually active, he will be faced with less risk of contracting sexually transmitted infections like syphilis, HIV/AIDS and other cancers,” she explained.

A couple from Ngwane Park also gave a testimonial, attesting that their seven-day old bouncing baby boy was circumcised at birth and had healed completely within the week as promised. These parents were not the only ones who gave touching testimonials as Edward Mtetwa of SBIS gave a touching lecture on the role of the father in raising kids.

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Buzzing in the Blogs

Global health expert Amanda Glassman sits down for the latest edition of CGD’s Global Prosperity Wonkcast to discuss the Global Fund.

We start with a discussion of the magnitude of global health funding (some $30 billion per year or about one-out-of-four aid dollars) and by getting to know the Global Fund – a multilateral agency that emerged from the G8 meeting process in 2002 when times were better and global health was seen as an area where money could make a difference.

“The Global Fund came out of an effort both to expand aid to developing countries and to reform aid,” Amanda tells me. “It was also a response to mounting pressure for action on a specific epidemic, HIV/AIDS.”

Contributions rose rapidly, with the lion’s share coming from the United States, followed by France, Germany, the UK and Japan. By 2008, the Global Fund was raising about $3 billion a year, or about 10% of global health aid (for more on the fascinating history of the Global Fund, see this CGD background paper).

In 2011, however, the Associated Press reported on what it called “massive corruption” at the Global Fund. This prompted a firestorm of criticism, much closer scrutiny of the Global Fund’s work, and a drop in funding, with several donors withholding their contributions.

Amanda and I discuss how Bill Savedoff pointed out that the amount of fraud uncovered was not so massive after all – only about 0.3 percent of total disbursements. However, because the Global Fund—like most other development agencies—does not conduct random audits, there was no way to know if the problems were an anomaly or the tip of the iceberg.

They were, however, a major distraction.

“It really is nothing, it’s budget dust,” says Amanda. “Still, you don’t want any misuse and fraud in programs obviously, and I think it’s a sign of the health of the organization that they were able to detect and report on [it]. But the size of that loss is minuscule and they’ve been paid it back… The system worked.”

The real problems at the Global Fund and other big health funders, Amanda tells me, are much more fundamental than the occasional corruption scandal.

For example, she says, although the Global Fund was a pioneer in performance-based funding (PBF), grants are generally judged on outputs (e.g. number of bednets purchased and distributed) rather than coverage or outcome indicators (e.g. proportion of children under age 5 sleeping under a bednet, or reductions in the number of cases of malaria).

“When you track how much money people have spent or how many things you’ve bought, that doesn’t always align with the goal of reducing disease as much as possible,” says Amanda.

Moreover, she says, the indicators are self-reported, making them vulnerable to manipulation.

“If the incentive is to achieve certain targets and they’re administrative-type targets and I’m not going to check it independently or I’m just going to make sure the paperwork matches, you see this tendency to meet all your goals,” she says.

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Capital Events

Thursday

8:30 AM – Infrastructure and Business Opportunities in North Africa – National Council on US-Arab Relations

11:00 AM – Sebastian Junger’s War and the Laws of War – American Red Cross

*3:00 PM – Policy Implications of The Lancet MSM and HIV Series – CSIS

4:00 PM – The United Nations Convention on the Rights of Persons with Disabilities and Its Impact on Human Rights – AU Law

Friday

9:30 AM – Kenya’s Momentous Year Ahead: A Conversation with Willy Mutunga Chief Justice of the Kenyan Supreme Court – CSIS

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By Mark Leon Goldberg and Tom Murphy; Photo Credit

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