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Stemming the Tide of Drug-Resistant Tuberculosis Stemming the Tide of Drug-Resistant Tuberculosis Handbook on Best Practices for Clinical and Program Management of Drug-resistant Tuberculosis: Lessons Learned from the Global Fund to Fight Aids, Tuberculosis, and Malaria TB Grants in Eastern Europe and Central Asia ISBN-13: 978-1-944302-03-0 ISBN-10:1-944302-03-4 http://ghd-dubai.hms.harvard.edu PROCEEDINGS Volume 1, Number 1, December 2014 Stemming the tide of drug-resistant tuberculosis Handbook on Best Practices for Clinical and Program Management of Drug-Resistant Tuberculosis: Lessons Learned from Global Fund to Fight AIDS, Tuberculosis, and Malaria TB Grants in Eastern Europe and Central Asia STEMMING THE TIDE OF DRUG-RESISTANT TUBERCULOSIS Contributors Chief Editors Elmira Berikova, Kazakhstan Salmaan Keshavjee, MD, PhD, ScM, Irina Gelmanova, United States Harvard Medical School Petr Golubchikov, Russian Federation Oksana Ponomarenko, PhD, Partners In Health Alexander Golubkov, United States Askar Yedilbayev, MD, MPH, Partners In Health Ali Habib, Pakistan Funders Hamidah Hussain, Pakistan GIZ BACK-UP Initiative Armen Hayrapetyan, Armenia Eli Lilly MDR-TB Partnership Hennandz Hurevich, Belarus Harvard Medical School Center for Giorgi Kuchukhidze, Georgia Global Health Delivery-Dubai Viktoriya Livchits, Russian Federation Partners In Health Rafael Mehtiyev, Azerbaijan Sergey Mishustin, Russian Federation Andrei Mosneaga, Moldova Reviewers Elchin Mukhtarli, Azerbaijan Evgenia Markvardt, Partners In Health Olga Pavlova, Ukraine Giselle Obregón, Harvard Medical School Sergiu Platon, Moldova Nataliya Morozova, Partners in Health Nina Polyakova, Russian Federation Suchitra Kulkarni, Harvard Medical School Alexandra Solovyova, Russian Federation Ola Morehead, Harvard College Dmitry Taran, Russian Federation Bekzat Toksanbayeva, Kazakhstan Copy-editor Gulnoz Uzakova, Uzbekistan Christine Wenc Tonka Varleva, Bulgaria Irina Vasilyeva, Russian Federation Designer Grigory Volchenkov, Russian Federation Lidia Churakova Nataliya Zemlyanaya, Russian Federation © Harvard Medical School Center for Global Health Delivery-- Dubai, 2016 This handbook is based on the collection of lectures presented at an international symposium entitled, “Stemming the Tide of Drug-Resistant Tuberculosis” held at the Harvard Medical School Center for Global Health Delivery-- Dubai in December 2014. The symposium was organized by Partners In Health and the Harvard Medical School Center for Global Health Delivery-- Dubai with generous support from the GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit) BACK-UP initiative. Support for the printing and design of this publication was provided by The Eli Lilly MDR-TB Partnership. PREFERRED CITATION: Stemming the Tide of Drug-Resistant Tuberculosis. Handbook on Best Practices for Clinical and Program Management of Drug-Resistant Tuberculosis: Lessons Learned from the Global Fund to Fight AIDS, Tuberculosis, and Malaria TB grants in Eastern Europe and Central Asia. Boston, MA. Partners in Health, Department of Global Health and Social Medicine, Harvard Medical School; April 2016. The contents of this report are the sole responsibility of its authors and do not necessarily reflect the views of Partners In Health, the Harvard Medical School Center for Global Health Delivery-- Dubai, the GIZ BACK- UP initiative, or the Eli Lilly MDR-TB Partnership. Harvard Medical School and its licensors at all times owns and retains the right, title, and interest in and to “Stemming the Tide of Drug-Resistant Tuberculosis: Lessons Learned from the Global Fund to Fight AIDS, Tuberculosis, and Malaria TB grants in Eastern Europe and Central Asia” (hereafter referred to as “the Hand- book”) including all intellectual property rights therein and thereto. You may use and copy the Handbook, or portions of the Handbook, provided that you reproduce all copyright notices, claims, or reservation of rights appearing in the Handbook, as delivered to you, on all copies made pursuant to this sentence. By using the Handbook, you acknowledge that (i) the Authors and Contributors are not guarantee-ing the completeness or accuracy of the information contained herein, (ii) the Handbook neither represents nor comprises all of the data or other information that may be relevant to you, (iii) portions of the Handbook may be outdated and may have been superceded by subsequent changes in applicable law, regulation, or conditions affecting the treatment of tuberculosis or the delivery of health care generally, and (iv) the Authors and Contributors do not have any duty to update the Handbook or, if updated, to provide further updated versions of the Handbook. To the maximum extent permitted under applicable laws, none of the Authors and Contributors are liable, under any circumstance or under any theory of law, tort, contract, strict liability or otherwise, for any direct, indirect, special, incidental, consequential, exemplary or punitive damages, or any other injury and/or damage (actual or perceived), including, without limitation, damages based on errors, omissions, or reliance upon, use, or operation of any ideas, instructions, procedures, products, or methods contained in the material included in this guide. By using the Handbook, you acknowledge and agree to the terms of this notice. For more information about the Harvard Center for Global Health Delivery-Dubai, please visit: http://ghsm.hms.harvard.edu/ghd-dubai/about-us For more information about the GIZ BACK-UP initiative, please visit: https://www.giz.de/expertise/html/7192.html For more information about the Eli Lilly MDR-TB Partnership please visit: http://www.lillyglobalhealth.com/en/mdr-tb/index.aspx For more information about Partners in Health, please visit: www.pih.org For more information about Partners In Health/Russia, please visit: www.pih.ru Printed in the United States of America. ISBN-13: 978-1-944302-03-0 ISBN-10: 1-944302-03-4 TABLE OF CONTENTS About Partners In Health ...................................................................................................... i About the “Stemming the Tide of Drug-Resistant Tuberculosis” symposium and the Handbook ............................................................................................. i Welcome Letter from Dr Paul Farmer to symposium attendees ..................................... 2 Session 1 ............................................................................................................................... 4 1.1 Best Practice: Clinical research and a program for compassionate use of bedaquiline, an example from Russia ..................................................... 4 Table 1.1.1. Impact of adding bedaquiline to the regimen on therapy efficacy .................. 5 1.2 Best Practice: Compassionate use program, an example from Armenia .......... 6 Figure1.2.1. TB morbidity and mortality in Armenia (2001-2013) ..................................... 6 Figure 1.2.2. Treatment success rates among new smear (+) patients ............................. 7 Figure 1.2.3 MDR-TB among new cases (2006-2013) ....................................................... 7 Figure 1.2.4. Absolute number of MDR-TB cases (2007-2013) ......................................... 8 Figure 1.2.5. Treatment success rates of MDR-TB cases (2007-2010) ............................. 8 Table 1.2.6. Treatment regimens with Bedaquiline ............................................................. 9 Figure 1.2.7. Social composition of TB patients (%) ........................................................... 9 Figure 1.2.8. Clinical structure of XDR-TB patients (%) ..................................................... 9 Table 1.2.9 . Bacteriological status after completion of 6-month course of Bdq, April 2013 – December 2014 .................................................................................. 10 Table 1.2.10. Bacteriological status, culture conversion by months, April 2013 – December 2014 .................................................................................. 10 Figure 1.2.11. Timeline of sputum conversion of XDR-TB patients (%/month) ................ 10 Figure 1.2.12. Healing of destructive changes in patients with XDR-TB (%) .................... 11 1.3 Best Practice: Addressing adverse reactions, an example from Tomsk, Russia ..................................................................................................... 12 Figure 1.3.1. Impact of patient centered approaches on treatment default patients in MDR-TB treatment; outcomes in the civilian sector (%) .................... 13 Figure 1.3.2. Number of MDR-TB patients in Tomsk Oblast, civilian sector (absolute number) .................................................................................................. 13 1.4 Best Practice: Treating patients with HIV and DR-TB, an example from Ukraine ........................................................................................ 14 Figure 1.4.1. Epidemiological TB and HIV situation in Ukraine .......................................... 15 Figure 1.4.2. Treatment effectiveness of TB and HIV in Ukraine ........................................ 16 Session 2 ............................................................................................................................. 17 Introduction: The Global Fund to Fight AIDS, Tuberculosis and Malaria: Plans to support the expansion of new drugs .................................. 17 2.1 Best Practice: Impact of the GFATM project on TB burden, an example from Tomsk, Russia .......................................................................
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