Why are new drugs and cheaper, more user friendly regimes needed?

* Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6.

"Tuberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a

cause of death continued to decline in areas in which headlines are written.”

Keshavjee and Farmer, NEJM, 2012*

And what TB crisis?

*Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6.

Cost-ineffective?

“…selective primary health care and ‘cost-effectiveness’ have shaped an anemic response to the ongoing global pandemic.”*

Slide courtesy: Prof Keertan Dheda

Financing the scale-up of MDR-TB prevention and Treatment. Katherine Floyd, Stop TB, WHO. Ministerial meeting. Beijing, China, 2009http://www.who.int/tb_beijingmeeting/media/press_pack/presentations/day2_presentation3.pdf

SA : MDR-TB already >55% of TB budget!

The perception among the majority is that we are not at risk of being infected by TB. This assumption is deeply flawed.

Dr Madhukar Pai, India Tribune, 29 October 2012

http://www.tribuneindia.com/2012/20121029/edit.htm#6

The RNTCP needs to think beyond treatment of drug-resistant TB, and focus on preventing a major epidemic. In the case of drug-resistant TB, an ounce of prevention

is definitely better than a pound of cure

Care for the carer• ±1/100: number of South Africans diagnosed with TB

last year (WHO, 2012). • 3x: increased rate of TB among Health Care Workers

globally (Baussano, 2011).• 6.3%: confirmed drug-resistance among occupational

TB cases at Tygerberg Hospital (Data: 2008-2011).• 5.56x higher incidence rate of MDR- and XDR

(O’Donnell, 2010)• Means 3/100 HCW’s could be diagnosed with TB every

year• At least 1/16 could have MDR-TB or worse

Lucky and thankful…• Dalene got her life back, she can still hear, and

can even practice as a clinician again…what next?

TB PROOF

Start at the beginning:

2nd Year Medical Students

Anyone can get TB

http://www.health24.com/tools/Slideshows/1891-4704-4775,61850.asp

Nobel peace prize TB survivors

“UBUNTU” – I am because we are

We are all in this together!

HOPE: Life after TB

SA record: 114m in one breath!

Thank you!Physicians:• Paul Willcox • Andreas Diacon• Simon Schaaf• Tony Biebuyck• Jantjie Taljaard• Keertan DhedaPharmacology• Gary Maartens• Elsimé Kift • Jeannine Du Bois Supportive• Justus Apffelstaedt - Surgery• Mou Manie - Rheumatology• Anton Doubell - Cardiology• Mark Abelson – Cardiology• Prof Loock – Ear, nose and throatRadiology• Sucari Vlok• Arthur Maydall • Jan Lotz Occupational Health/TBH• Jack Meintjies• Sr Samuels• Sr Arendse• Matodzi Mukosi - super• Elmarie Malek• Mariana KrugerSAMA - Daniel Madiba

CBTBR/Genetics:• Gerhard Walzl• Belinda Kriel• Daleen Kriel• Rob Warren• Tommie Victor• Soraya Bardien-Kruger• Lizma StreicherTibotec/Janssen:• David McNeeley• Gilles van BaarNHLS • Mariza Hoffman• Haematology and Microbiology

TechnologistsAudiology:• Rene Visagie• Sharon Pithey• Tygerberg AudiologistsCAPRISA• Nesri Padayatchi• Kogieleum NaidooTB PROOF• Angela Dramowski• Bart Willems• Heena Narotam• Helene-Mari van der Westhuizen• Koot KotzeTreatment Action Group

“The momentum to break this disease is in real danger. We are now at a crossroads between TB elimination within our lifetime, and millions

more TB deaths.”

Dr Mario Raviglione; Director of the WHO Stop TB Department; 17 October 2012

Questions?