Activist confronts the “father” of drug-resistant TB

The following is a guest post by Abigail Mudd, MPH A human rights lawyer and two-time tuberculosis survivor, Timur Abdullaev is an international TB activist. He owes his life, he says, to treatment supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and now he also depends on the multilateral initiative for his continued health. He remains at risk, he knows, of acquiring another infection, and it, too, progressing to TB disease, unless the latent infection is promptly detected and treated. There is, however, no gold standard for testing for latent TB. The two tests used, the tuberculin skin test and the interferon-gamma release assay, require the patient’s immune system to react strongly enough to detect, which may not happen in a patient who, like Abdullaev, is living with HIV. So, every spring, Abdullaev takes a course of antibiotics just in case. Standard TB preventative therapy requires patients to take the drug isoniazid daily for six months. Now, Abdullaev has access to a new preventive treatment regimen –  3HP or “the 12-dose regimen,” recently approved by the US Food and Drug Administration – consisting of a course of two antibiotics (isoniazid and rifapentine) taken once a week for 12 weeks. Thanks to the Global Fund, because he is living with HIV, Abdullaev falls into the few who can access the regimen in Uzbekistan, but the regimen remains hard to come by in pharmacies. His wife and children, who have also been treated for TB disease, are not eligible to receive it. The ramifications of this, Abdullaev said, go well beyond impacts to his immediate family. “Under-funded health systems are the mother of multidrug-resistant TB,” he told Science Speaks, “lack of attention is the father.” And while the Global Fund is the biggest international funding source for TB responses in low income countries, as Eastern Europe economies grow, the role of the initiative is receding, leaving some national budgets to pick up the costs of first-line TB medications. In some cases, this is a positive change. But, as Abdullaev looks to the first anniversary of the 2018 United Nations High-Level Meeting on Ending TB, he wonders how the global community will meet the goals set out there:

• To successfully treat 40 million people with TB by 2022 including 3.5 million children and 1.5 million people with drug resistant TB;
• To treat at least 30 million people for latent TB by 2022, including 4 million children, 20 million other household contacts of people affect by TB, and 6 million people living with HIV.

To meet these goals, and others falling into sustainable development goal targets, and aims made realizable by biomedical advances against TB and HIV, the Global Fund has called for a $14 billion increase in donations. Even with this increase, Abdullaev argues that research and development, TB response, and community response will remain woefully underfunded. The Global Fund’s third replenishment will expire in October and requires renewal. In July, the United States House of Representatives approved a $210 million increase for to U.S. Global Fund contribution. Whether that will receive Senate approval, and materialize, remains to be seen.