‘€œIf you look for it (drug-resistant TB), you will find it,’€ said Dr Helen Cox of Médecins Sans Frontières (MSF).

In Africa, there is a low percentage of drug-resistant TB reported among new cases compared with regions such as Eastern Europe and Central Asia. However, there is an understanding that this may be due in part to the limited laboratory capacity to conduct drug resistance surveys.

Current data reveals 28% of all people newly diagnosed with TB in one region of north western Russia had the multidrug-resistant form of the disease in 2008. This is the highest level ever reported to the World Health Organisation. Previously, the highest recorded level was 22% in Baku City, Azerbaijan, in 2007.

Cox and her colleagues (including the city and provincial health services) conducted a survey in Khayelitsha in 2008 among TB patients and found that 5% of the new TB patients (223) were resistant to rifampicin, the most effective anti-TB drug.

Rifampicin resistance was also found in 168 (11%) of the previously treated cases. This translated into 391 patients with rifampicin resistance which is 80 patients per 100 000 cases, higher than in most East European countries. In 2009, 17% of the Khayelitsha patients found were resistant to one or more of the TB drugs.

Cox said that many patients also died before they were diagnosed or able to access treatment. In Khayelitsha it was found that as many as 10% of patients died before they received the results confirming whether they had drug-resistant TB. The drug sensitivity tests take between eight and 10 weeks.

She said early detection of drug-resistant TB was critical and that new diagnostics had to be fast tracked. The Gene Xpert cuts the diagnosis to 90 minutes and is simple to operate, but it is unaffordable for most high burden countries.

 Despite this grim picture MSF was recording massive improvements in outcomes by diagnosing patients, educating them regarding their treatment, giving support at home, treating them as outpatients and implementing infection control in the home and at the clinics.

After 18 months 60% of drug-resistant patients on the MSF programme were still alive, compared to 70% of patients dying in similar settings around the world.

Cox said the new anti-TB drug Moxifloxacin was showing great promise in Khayelitsha, but that is was very expensive. ‘€œWe need advocacy to push for it to become more affordable,’€ she said.

·                 Multidrug-resistant TB (MDR-TB) is caused by bacteria that are resistant to at least isoniazid and rifampicin, the most effective anti-TB drugs. MDR-TB results from either primary infection with resistant bacteria or may develop in the course of a patient’€™s treatment.

·                 Extensively drug-resistant TB (XDR-TB) is a form of TB caused by bacteria that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as any fluoroquinolone and any of the second-line anti-TB injectable drugs (amikacin, kanamycin or capreomycin). These forms of TB do not respond to the standard six-month treatment with first-line anti-TB drugs and can take up to two years or more to treat with drugs that are less potent, more toxic and much more expensive, from 50 to 200 times higher. While a course of standard TB drugs cost approximately US$ 20, MDR-TB drugs can cost up to US$ 5 000, and XDR-TB treatment is far more expensive.