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The Union to launch international trial of 9-month MDR-TB treatment regimen

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Bobby Ramakant - CNS
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World TB Day, 24 March 2010

In this year 2010, which has been declared as Year of the Lung, it is indeed a much-awaited welcome news that International Union Against Tuberculosis and Lung Disease (The Union) is to launch an International trial of 9-month MDR-TB treatment regimen. The need for accessible, effective multidrug-resistant tuberculosis treatment is urgent, as the incidence of MDR-TB continues to rise, and extensively drug-resistant TB (XDR-TB) has been reported in 57 countries. In response, the International Union Against Tuberculosis and Lung Disease (The Union) is launching a trial of a 9-month treatment regimen that has demonstrated cure rates exceeding 80% in a pilot programme.

While tuberculosis has been curable for more than 60 years, drug-resistant strains are far more difficult and costly to treat. Currently used treatment regimens can take up to two years to complete, placing a heavy burden on both patients and health systems.

The Union's evaluation of a standardised treatment regimen of anti-tuberculosis drugs for patients with multiple drug-resistant tuberculosis or STREAM will seek to determine whether a regimen developed and implemented by the Damien Foundation and the Institute of Tropical Medicine, and used with notable success in Bangladesh, can be used in different settings with comparable results.

"Obviously, this regimen represents a significant difference in time and resources for all involved", says Dr Nils E Billo, Executive Director of The Union. "But any treatment strategy must be carefully evaluated to ensure the most effective and feasible approaches are implemented, particularly in low-income settings where MDR-TB is most prevalent."

To prepare for and implement the single-arm, multicentre STREAM study, The Union is collaborating with the Medical Research Council of the United Kingdom. The four-year study will involve close to 600 patients in four different countries, which are in the process of being selected. Selection will be based on the country's disease burden of TB, MDR-TB and TB-HIV co-infection, as well as other criteria such as ability to provide close supervision of patients, quality of lab facilities and the full support of the national tuberculosis programme..

The STREAM study is part of the USAID-funded initiative led by The Union called Technology, Research, Education and Technical Assistance for Tuberculosis TREAT TB. Consistent with the goals of TREAT TB, the overarching goal of STREAM is to see that research, technology and education are increasingly used to improve the performance of patient management practices in the countries selected for the trial. The outcomes of the study are expected to provide important evidence to inform MDR-TB treatment recommendations from global technical agencies, including the World Health Organization and The Union and national policy and guidelines for MDR-TB treatment in high-burden countries.

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Bobby Ramakant is a World Health Organization (WHO) Director-General's WNTD Awardee for the year 2008, and writes extensively on health and development for Citizen News Service (CNS). Website: www.citizen-news.org
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