MDR-TB: Experts warn of a costly battle ahead

The finishing tape is about nine months away and Bangladesh is not even on the track to meet millennium development goals to beat TB.

The race is only getting tougher with the spread of Multi Drug Resistant TB, a variant of the deadly blight that outmanoeuvres the first line of medicines.

Experts, ahead of "World Tuberculosis Day 2015" on Tuesday, tell bndews24.com that there is no room for complacency even if Bangladesh did achieve some success in two of the four TB-related points on the MDG list.

The country met the Millennium Development Goal for restricting TB in terms of detection (MDG 6.10a) as well as curing of the detected cases (MDG 6.10b) of the ‘communicable’ disease. Those targets, however, did not aim for a complete eradication in the first place.

An undetected patient, as one study suggests, is enough to put ten individuals at risk. Then, there are targets — of limiting prevalence of (MDG 6.9a) and death of TB (MDG 6.9b) by designated rates — that have not quite been met.

The latest (2014) WHO Global TB Report says 29% of the afflicted and partially cured TB patients return with MDR-TB.

This, according to Dr. Shayla Islam, Programme Manager, Tuberculosis Control Program, BRAC, is grave enough to "recognise TB as a major threat to public health”.

National Tuberculosis Control Programme (NTP) was able to treat only 684 cases of MDR-TB by 2013.

They are among the 5,000 reported cases.

"This number”, says Dr. Anna Vassal, an economist working with London School of Hygiene and Tropical Medicine, "is likely to be much less than the real affliction levels to find and diagnose the real levels of drug resistance”.

Dr. MA Hamid Salim, Advisor to NTP Bangladesh on Global Fund and MDR-TB, shares the same concern. "These estimates might not present the reality of TB affliction in the country,” he says.

"The National TB Control programme is at the moment conducting a prevalence survey which will provide better estimates and we would be able to know more accurately where does Bangladesh TB Control programme stands in relation to MDG."

In detecting MDR-TB, however, Bangladesh has made some progress, Dr. Salim informs.

"Specifically for MDR-TB case detection a new technology called 'Gene-Xpert' has been introduced in 39 places of the country. Through this new technique MDR TB can be detected within two hours, instead of 12 weeks through conventional method.”

"NTP plans to procure more Gene-Xpert at least to cover every district."

Dr. Salim explains why the programme badly needs generous support from the government and development partners.

While NTP is doing what it can do best, "there are 140,000 patient’s samples waiting to be transported to one of its testing facilities”.

"The origins of MDR-TB”, says Dr. Vassal, "lie in previous failure to properly treat normal cases of TB."

"If treatment is not completed then the patient can develop MDR-TB. Once this has happened in the past, these patients can infect other patients who then get MDR-TB as their main form of TB."

"So the first line of defence”, Dr. Vassal highlights, "is always to treat all cases of TB properly and ensure people complete their treatment course.”

It is always better and many times cheaper to treat the disease in its non-drug resistance form. General expenses of treating MDR-TB patients per person are around 6000(USD) (Source: NTP PMDT Expansion plan, Bangladesh (2013 – 2017))

Dr. Vassal, who conducts research on the economics of TB at the top medical research university, explains why the actual cost is even greater.

“We know that normal TB can be catastrophic to many households (at around 10-20000 BDT per person). This is for illness and course of treatment of around six months. MDR-TB lasts longer, and can take up to 24 months to treat.

"Studies in other countries have shown that the experience of MDR-TB is likely to send most poor families into economic catastrophe. This can be made worse as MDR-TB is infectious so more than one household member may be infected.”

Dr. Shayla of BRAC Tuberculosis Programme, the most widespread TB control initiative, refers to a study in Ethiopia that says, “a total of 72% MDR TB patients reported losing their jobs and 79% reported an average income reduction of 100% for themselves.”

It may get as bad in Bangladesh.

According to Dr. Salim from NTP, at least 37000 patients at the moment need social support packages and that's not a small number.

That should mean Bangladesh prioritises TB as a major post-2015 agenda.