SEATTLE, Washington — Multidrug-resistant tuberculosis (TB) may be a greater problem than previously thought — especially in children. According to a new study carried out by Sheffield University, the World Health Organization (WHO) and Imperial College London, “Far more drug-resistant tuberculosis occurs in children than is diagnosed, and there is a large pool of drug-resistant infection.”
Using new data modeling, the researchers found that five million children around the world are infected with a strain of TB that resists Isoniazid – one of the most potent drugs in the treatment arsenal – and that two million have multidrug-resistant TB (MDR TB), dwarfing previous estimates. Tuberculosis in children is especially hard to diagnose and track, but WHO and other organizations dedicated to fighting TB are working to understand and reduce its incidence in children.
The Borgen Project spoke with Pete Dodd, health economics researcher at Sheffield University and one of the authors of the study, who said organizations like the WHO had a lot to learn about diagnosing, treating and collecting data on TB in children. “I think the most striking thing is the gap between the number of [MDR] cases that are appropriately diagnosed and treated, and the number we think are really out there. For DR-TB in children, this is a double gap.”
The study, published in the Lancet in June, also underscores the growing problem of drug resistance, perhaps the most complex hurdle in the global fight against TB. Most patients recover with the help of TB medications and then spread the tougher strain to others. An infection with drug-resistant bacteria is a much greater challenge – it can take more than two years to cure, even if the patient never misses a dose. Merely reaching the sick with the proper medication will not be enough to eradicate the disease.
Saving patients with MDR TB isn’t impossible, but preventing resistance is much more effective. Operation ASHA (OpASHA), an initiative based in India where TB is one of the greatest menaces to public health, could prove invaluable in this global effort. According to their website, OpASHA has treated 100 patients with MDR TB, not to mention “it is the exclusive provider of TB treatment to nearly [five]million Indian citizens,” many of whom live in rural areas with minimal access to healthcare. The organization also provides free testing at government labs. But probably most important is OpASHA’s methodology that prevents the emergence of MDR TB.
OpASHA provides patients with “comprehensive counseling” and monitors their courses of treatment. The group relies mostly on eCompliance, a technology system that tracks and collects data on each patient’s medication adherence. If a patient prematurely stops taking the medicine, the technology alerts the patient, a health worker, and his or her supervisor. The health worker meets with the patient within 48 hours, offers counseling to encourage adherence to the medication schedule, delivers the dose and collects a fingerprint from the patient on a tablet computer.
This method has proved extremely successful, achieving a treatment success rate of 87 percent and a default rate of just three percent – up to twenty times more effective than other methods. The technology has been adopted by initiatives in Uganda, Kenya and the Dominican Republic.
Despite such success, treating child patients remains a difficult task, even for OpASHA. Sandeep Ahuja, chief executive of OpASHA, described in a voice-memo the many ways that the organization treats children, but he explained that dealing with young kids poses unique challenges. According to Ahuja, the Indian government only supplies TB drugs in the form of tablets, which children are reluctant to take. To treat kids under the age of 10, pills are broken into smaller pieces, which can lead to inaccurate dosages. No pediatric doses officially exist for such small children. “Believe me, it is a difficult process,” Ahuja said.
If we are to see MDR TB incidence in children decrease, it is going to require more endurance, urgency and determination on the part of international governments and aid organizations. As Dr. Dodd explained, there is no silver bullet in this fight, but “preventative regimens” may be the best bet in places with high disease resistance burdens. Prevention is likely the best and maybe the only sustainable means of fighting MDR TB, and that is precisely why OpASHA’s patient-focused model is compelling.
“Our long-term plan is to ensure high-quality treatment for every patient across the world,” Mr. Ahuja said, “but we need to move even faster.”
– Charlie Tomb