Bridging the growing gap between diagnosis and treatment in multidrug-resistant tuberculosis (MDR-TB)
TB diagnostics and laboratory strengthening
An unprecedented scale-up in test development and laboratory strengthening has been seen since 2009, when the World Health Assembly called for universal access to tuberculosis (TB) drug susceptibility testing (DST) and treatment of all patients with drug-resistant disease. Six DST technologies were subsequently approved by the World Health Organization (WHO) and the uptake of new, rapid diagnostics was catalyzed by synergistic investments from national governments, donors and implementing partners. As a result, in-country laboratory capacity to detect multidrug-resistant TB (MDR-TB) has significantly improved, as outlined recently in the 2014 WHO Global Report.
Drug resistance surveillance data indicate that in 2013, approximately 480 000 people developed MDR-TB worldwide. If all notified TB patients (6.1 million, new and previously treated) had received a DST in 2013, an estimated 300 000 cases of MDR-TB would have been detected. Of these, 136 000 were actually diagnosed and reported to WHO in 2013, which represents a tripling in MDR-TB detection compared with 2009 (but nevertheless shows a continuing gap in diagnosis).
As the scale-up of rapid diagnostics continues, increasingly more patients will be detected with MDR-TB. A major challenge will be to ensure that all persons diagnosed with MDR-TB are started on treatment. Reducing and eliminating the growing gap between diagnosis and treatment need concerted effort by all partners in TB control. Addressing poor treatment outcomes for patients due to inadequate drug regimens, non-completion of therapy, and health system weaknesses are overlapping priorities for the Global Laboratory Initiative (GLI) and the Global Drug Resistance Initiative (GDI).