Last year on this blog, I wrote about why the United States and Eastern Europe and Eurasia need to work together to fight against multi-drug resistant (MDR) – tuberculosis (TB) and extensively drug-resistant (XDR) –TB. In the world of modern travel, these diseases are a plane ride away from our shores.
As we commemorate World Tuberculosis Day this year, Eastern Europe and Eurasia continue to have the highest rates of MDR-TB and XDR- TB in the world. Of the 27 countries with a high burden of M/XDR-TB, 10 are in the Europe/Eurasia region. MDR-TB is a national security interest and a global health interest for the region and for the world.
Tuberculosis is largely curable but also potentially deadly. It exacts an enormous personal and economic toll, often striking people in their most economically productive years. Diagnosis and treatment of MDR-TB and XDR-TB are more complicated and expensive. MDR-TB for example requires 24 months of treatment vs. 6 months for drug-susceptible TB and the treatment is more than 260 times more expensive. As a result, M/XDR-TB constitute major risks to effective TB control.
Europe and Eurasia are of particular concern because they have shown the world’s highest rates of MDR-TB. A 2011 USAID-funded survey in Minsk, Belarus found the highest MDR-TB rates recorded to date. Prior to that, one region in Russia and Baku, Azerbaijan had the highest recorded rates.
The picture of TB in the region is unique, fueled by inadequate diagnostics, poor compliance with treatment and insufficient infection control. The growth of HIV/AIDS further contributes to TB rates. In addition, TB programs historically have been implemented in a silo fashion separate from the rest of the health care systems, and drug regimens have been improperly prescribed and/or incompletely followed by patients.
In response to alarming new rates of MDR-TB USAID, working in collaboration with national TB programs and the Global Fund, has invested strategically and targeted areas where it can have the highest impact: strengthening surveillance systems, improving the quality of data collection and monitoring, strengthening laboratories, improving infection control, strengthening treatment services, bolstering drug management practices, and improving policies and protocols.
For example, USAID has helped to support the adoption of eTB Manager in several countries, including Armenia, Azerbiajan, Georgia and Ukraine. It is a web-based information system that captures specific information on TB including case management, labs and diagnostics, and drugs. It is an integral part of a larger national information system that needs to be put in place in order to adequately manage a national TB program. Ukraine was one of the earliest countries to implement eTB Manager, and it has now become the country-wide tool for monitoring and managing TB and MDR-TB. It will soon be scaled up to all public sector health care facilities in 2012. It is through successes like these that we can help to tackle and reduce the burden of TB.
USAID assistance to the region has become even more critical as support from the Global Fund and other sources have become more constrained. Through our efforts to combat TB and MDR-TB in Europe and Eurasia, USAID is helping to save thousands of lives and showing the goodwill of the American people.
In his 1961 Inaugural Address, President Kennedy spoke of the need to “struggle against the common enemies of man: tyranny, poverty, disease, and war itself.” He asked: “Can we forge against these enemies a grand and global alliance, North and South, East and West, that can assure a more fruitful life for all mankind?” Today, President Kennedy’s words remain as relevant as ever. We need to join forces to beat back TB for the good of all.