March 31st, 2011
Last week saw the passing of another World TB Day (March 24th), the third since the founding of Moxafrica. This time, we spent the day itself training carers in Robertson, South Africa.
As usual, it was accompanied by a report from the WHO on the state of global drug resistance.
What follows below is a summary of our analysis of the report from the perspective of the Moxafrica charity.
It is not all bad news, but it does smack a little of papering over the cracks. It fails to set the alarm bells ringing nearly as loudly as it should do, and also continues to pretty much generally ignore African countries - the only ones identified as having DR problems in fact are South Africa, the DR of Congo, Nigeria and Ethiopia (and only South Africa has any sort of diagnostic or surveillance infrastructure so it is hard to understand how they have definitively worked these others out). With regards to Africa, it is hardly possible that the report is in any way accurate and is merely reflective of the huge epidemiological hole which the continent is suffering from in terms of available data. We are reminded of the stament made by Dr Jim Yong Kim a year ago. Dr Kim is a Professor of Medicine and Social Medicine at Harvard Medical School, and is former Director of the WHO HIV/AIDS Department. He wrote chillingly: "Every time we look the problem is worse than we thought. Now it is coming together with HIV in sub-Saharan Africa, and it could be the most frightening thing we are ever going to see."
The report also identifies that there are literally no paediatric drugs available for treating DR-TB, while between 10 and 15% of DR-TB patients are estimated to be kids...
Appallingly, it also looks like the South African public sector is paying way more than others who are also treating DR TB. PAS 4g sachets, which are being sold to the South African government at R80 per sachet (daily dose), are being bought by MSF international for R21....
What a business.
It also suggests that, in contrast to the WHO report, as few as 6,000 patients were enrolled in GLC-approved treatment programmes, in comparison to their own estimated 440,000 new cases of DR-TB (around 1.4% ot the total, or a tenth of the WHO estimate).
Furthermore (and these quotations are of direct relevance to the non-pharmaceutical approach which lies at the heart of the Moxafrica project) they state that -
- "The interactions of DR-TB drugs with AIDS medicines are largely unknown...This is particularly problematic given that TB is the biggest killer of people lving with HIV today"
- "Today's treatment for DR-TB is largely based on experience and expert opinion, not studies or clinical trials, with a large number of "gray areas" where expert opinion may be conflicting"
- "The current objective is to develop and deliver a new short term regimen able to treat drug-sensitive and drug-resistant TB, and is also compatible with HIV treatment...it is questionable whether this objective can be achieved within reasonable time lines".
Once again we ask whether moxa treatment just might fill these gaps on exactly these terms. Step by step we are committed to continuing to find out.