In 2010, a survey conducted in Minsk, Belarus found that nearly one out of every two (47.8 percent) tuberculosis patients had multidrug-resistant TB (MDR-TB) -- a form of the disease that's resistant to, at the least, the two most powerful anti-TB medicines.
These were the highest MDR-TB levels ever recorded. In response, the Belarusian Ministry of Health conducted a nationwide survey to better understand drug resistance across the country, as well as the risk factors that lead to MDR-TB.
The national survey found similar levels to the initial Minsk survey: 35 per cent of new TB cases and 45 per cent of all TB patients in the study had MDR-TB. Of those with MDR-TB, 12 per cent had extensively drug-resistant TB (XDR-TB), a form of resistance to second-line drugs that develops on top of MDR-TB. The results confirm the alarming levels of drug resistance first found in Minsk are not restricted to the capital city, but are widespread across the country.
The high level of new TB cases that have MDR-TB indicates that MDR-TB is easily being transmitted throughout the population. The authors cite poor management of TB patients, including poor lab facilities for TB diagnosis, a lack of standardised treatment, poor infection control within hospitals, failure in directly observing treatment, lack of patient support, drug stock-outs and little, if any, monitoring of treatment outcomes, as factors that have led to such high levels of drug resistance.
The study also found that more than half of patients who had previously been treated for TB had MDR-TB, indicating that the current treatment of drug sensitive TB cases is ineffective. The study urges for a series of measures to be implemented in order to respond to these worryingly high levels of drug-resistance:
- Introduce molecular diagnostic tests, such as the GeneXpert machine, to screen all TB patients for drug resistance. Using a microscope will not determine if a patient is drug resistant, whereas the GeneXpert machine can detect resistance to rifampicin, one of the main first-line TB drugs.
- Improve infection control to stop the spread of drug-resistant strains.
- Provide a strong patient-centred system of incentives and enablers, given that almost half of TB patients in the study were unemployed and more than half had issues of alcohol abuse.
Belarus currently faces a severe funding gap for its national TB programme, and funding plans have been further hampered as Belarus was prevented from applying for funding from the Global Fund to Fight AIDS, TB and Malaria in their last funding round. As outlined in our report Bridging the Gap: Why the European Union must address the Global Fund’s funding crisis to tackle the escalating HIV and TB epidemics in Eastern Europe and Central Asia:
It has been estimated that the funding gap in Belarus for the five-year period between 2012 and 2016 will be US$ 16 million per year. US$ 15 million of this will be needed for second-line treatment of MDR-TB and XDR-TB, US$ 300,000 for rapid laboratory diagnostics. and about US$ 500,000 for essential patient support programmes to ensure treatment completion.
How the funding gap in Belarus will be filled remains uncertain. However, it is clear is that external funding, including Global Fund financing, will be the only way that Belarus will be able to scale up their MDR-TB response to the level required to address the serious trend in drug-resistant TB.