Access to new medications for the treatment of drug-resistant tuberculosis: patient, provider and community perspectives

Erica Lessem; Helen Cox; Colleen Daniels; Jennifer Furin; Lindsay McKenna; Carole D Mitnick; Thato Mosidi; Caitlin Reed; Barbara Seaworth; Jonathan Stillo; Phumeza Tisile; Dalene von Delft

doi:10.1016/j.ijid.2014.12.012

Access to new medications for the treatment of drug-resistant tuberculosis: patient, provider and community perspectives

Int J Infect Dis. 2015 Mar:32:56-60. doi: 10.1016/j.ijid.2014.12.012.

Authors

Affiliations

¹ Treatment Action Group, New York, NY, USA. Electronic address: erica.lessem@treatmentactiongroup.org.
² Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
³ Treatment Action Group, New York, NY, USA.
⁴ TB Research Unit, Case Western Reserve University, Cleveland, OH, USA.
⁵ Department of Global Health and Social Medicine, Harvard Medical School; Partners In Health; Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA.
⁶ TB Proof, Cape Town, South Africa.
⁷ Olive View-UCLA Medical Center Inpatient Tuberculosis Unit, Sylmar, CA, USA.
⁸ University of Texas Health Science Center, Tyler, and Heartland National TB Center, San Antonio, TX, USA.
⁹ City University of New York Graduate Center, NY, USA.
¹⁰ Independent activist, Cape Town, South Africa.

PMID: 25809757
DOI: 10.1016/j.ijid.2014.12.012

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is on the rise, and is difficult to treat. The approval of two new drugs, bedaquiline and delamanid, and growing evidence for the use of linezolid, offer renewed hope for addressing MDR-TB. However, access to these medicines remains a significant challenge. These drugs have not been registered for TB in most settings; barriers to preapproval access persist; and high pricing and intellectual property restrictions limit access. Many unanswered research questions about optimal use of these drugs also limit access, particularly for vulnerable populations. This review outlines challenges in accessing drugs encountered from the perspective of clinicians, patients and affected communities, and offers potential solutions.

Keywords: Access; Community; Compassionate use; Drugs; Multidrug-resistant tuberculosis; Tuberculosis.

Publication types

Review

MeSH terms

Antitubercular Agents / economics
Antitubercular Agents / therapeutic use*
Compassionate Use Trials
Diarylquinolines / therapeutic use
Health Services Accessibility
Humans
Linezolid / therapeutic use
Nitroimidazoles / therapeutic use
Oxazoles / therapeutic use
Tuberculosis, Multidrug-Resistant / drug therapy*
Vulnerable Populations

Substances

Antitubercular Agents
Diarylquinolines
Nitroimidazoles
OPC-67683
Oxazoles
bedaquiline
Linezolid