National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

Facing the Reality of Drug-Resistant Tuberculosis in India

Challenges and Potential Solutions

SUMMARY OF A JOINT WORKSHOP

by the Institute of Medicine,

the Indian National Science Academy, and

the Indian Council of Medical Research

Steve Olson, Rebecca A. English, Rita S. Guenther, and
Anne B. Claiborne, Rapporteurs

Forum on Drug Discovery, Development, and Translation

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This study was supported by contracts between the National Academy of Sciences and Department of Health and Human Services (Contract Nos. N01-OD-4-2139 and 223001003T), U.S. State Department (S-LMAQM-08-GR-071), American Society for Microbiology, Amgen Inc., Association of American Medical Colleges, Bristol-Myers Squibb, Burroughs Wellcome Fund, Celtic Therapeutics, LLLP, Critical Path Institute, Doris Duke Charitable Foundation, Eli Lilly & Co., FasterCures, Foundation for the NIH, Friends of Cancer Research, GlaxoSmithKline, Johnson & Johnson, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, and Pfizer Inc. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-21966-2
International Standard Book Number-10: 0-309-21966-3
ISBN 0-309-21966-3

Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2012 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

–Goethe

image

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

PLANNING COMMITTEE ON FACING THE REALITY
OF DRUG-RESISTANT TUBERCULOSIS IN INDIA:
CHALLENGES AND POTENTIAL SOLUTIONS1

GAIL H. CASSELL (Chair), Harvard Medical School (visiting)

BARRY R. BLOOM, Harvard School of Public Health

ENRIQUETA C. BOND, QE Philanthropic Advisors

RICHARD E. CHAISSON, Johns Hopkins University

PAUL E. FARMER, Partners In Health, Harvard Medical School

ANTHONY S. FAUCI, National Institute of Allergy and Infectious Diseases

GARY L. FILERMAN, Atlas Health Foundation

GERALD H. FRIEDLAND, Yale University School of Medicine

ELAINE K. GALLIN, QE Philanthropic Advisors

STEPHEN GROFT, National Center for Advancing Translational Sciences

NANCY SUNG, Burroughs Wellcome Fund

IOM Staff

ANNE B. CLAIBORNE, Forum Director

RITA S. GUENTHER, Program Officer

REBECCA A. ENGLISH, Associate Program Officer

ELIZABETH F. C. TYSON, Research Associate

ANDREW M. POPE, Director, Board on Health Sciences Policy

ROBIN GUYSE, Senior Program Assistant

RONA BRIERE, Consulting Editor

Indian National Science Academy (INSA) Staff

KRISHAN LAL, President

PRAKASH N. TANDON, Past President

A. K. JAIN, Inter Academy Officer

____________________

1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

Indian Council of Medical Research (ICMR) Staff

VISHWA MOHAN KATOCH, Director General

LALIT KANT, Head, Division of Epidemiology and Communicable Diseases

MANJULA SINGH, Scientist C

HARPREET SANDHU, Scientist D

MUKESH KUMAR, Scientist E and Head

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

FORUM ON DRUG DISCOVERY,
DEVELOPMENT, AND TRANSLATION1

JEFFREY M. DRAZEN (Co-Chair), New England Journal of Medicine, Boston, Massachusetts

STEVEN K. GALSON (Co-Chair), Amgen Inc., Thousand Oaks, California

MARGARET ANDERSON, FasterCures, Washington, DC

HUGH AUCHINCLOSS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland

LESLIE Z. BENET, University of California, San Francisco

ANN BONHAM, Association of American Medical Colleges, Washington, DC

LINDA BRADY, National Institute of Mental Health, Bethesda, Maryland

ROBERT CALIFF, Duke University Medical Center, Durham, North Carolina

C. THOMAS CASKEY, Baylor College of Medicine, Houston, Texas

GAIL H. CASSELL, Harvard Medical School (visiting), Carmel, Indiana

PETER B. CORR, Celtic Therapeutics, LLLP, New York, New York

ANDREW M. DAHLEM, Eli Lilly & Co., Indianapolis, Indiana

TAMARA DARSOW, American Diabetes Association, Alexandria, Virginia

JAMES H. DOROSHOW, National Cancer Institute, Bethesda, Maryland

GARY L. FILERMAN, Atlas Health Foundation, McLean, Virginia

GARRET A. FITZGERALD, University of Pennsylvania School of Medicine, Philadelphia

MARK J. GOLDBERGER, Abbott Pharmaceuticals, Rockville, Maryland

HARRY B. GREENBERG, Stanford University School of Medicine, California

STEPHEN GROFT, National Center for Advancing Translational Sciences, Bethesda, Maryland

LYNN HUDSON, Critical Path Institute, Tucson, Arizona

THOMAS INSEL, National Center for Advancing Translational Sciences, Bethesda, Maryland

MICHAEL KATZ, March of Dimes Foundation, White Plains, New York

PETRA KAUFMANN, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland

____________________

1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

JACK D. KEENE, Duke University Medical Center, Durham, North Carolina

RONALD L. KRALL, University of Pennsylvania, Center for Bioethics, Steamboat Springs, Colorado

FREDA LEWIS-HALL, Pfizer Inc., New York, New York

MARK B. MCCLELLAN, The Brookings Institution, Washington, DC

CAROL MIMURA, University of California, Berkeley

ELIZABETH (BETSY) MYERS, Doris Duke Charitable Foundation, New York, New York

JOHN ORLOFF, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey

AMY PATTERSON, National Institutes of Health, Bethesda, Maryland

MICHAEL ROSENBLATT, Merck & Co., Inc., Whitehouse Station, New Jersey

JANET SHOEMAKER, American Society for Microbiology, Washington, DC

ELLEN SIGAL, Friends of Cancer Research, Washington, DC

ELLIOTT SIGAL, Bristol-Myers Squibb, Princeton, New Jersey

ELLEN R. STRAHLMAN, GlaxoSmithKline, Research Triangle Park, North Carolina

NANCY SUNG, Burroughs Wellcome Fund, Research Triangle Park, North Carolina

JANET TOBIAS, Ikana Media and Mount Sinai School of Medicine, New York, New York

JOANNE WALDSTREICHER, Janssen Research & Development, LLC, Raritan, New Jersey

JANET WOODCOCK, Food and Drug Administration, White Oak, Maryland

IOM Staff

ANNE B. CLAIBORNE, Forum Director

RITA S. GUENTHER, Program Officer

REBECCA A. ENGLISH, Associate Program Officer

ELIZABETH F. C. TYSON, Research Associate

ANDREW M. POPE, Director, Board on Health Sciences Policy

ROBIN GUYSE, Senior Program Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for clarity, objectivity and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:

Digambar Behera, Lala Ram Sarup Institute of TB and Respiratory Diseases

Vishwa Mohan Katoch, Indian Council of Medical Research

P. R. Narayanan, National Institute for Research in Tuberculosis, Chennai

K. Srinath Reddy, Public Health Foundation of India

Christine F. Sizemore, National Institute of Allergy and Infectious Diseases

Soumya Swaminathan, National Institute for Research in Tuberculosis, Chennai

Prakash N. Tandon, Indian National Science Academy

Kristina Wallengren, KwaZulu-Natal Research Institute for Tuberculosis and HIV, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

Although the reviewers listed above provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

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Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×

Acronyms

AIDS      acquired immune deficiency syndrome
AIIMS      All India Institute of Medical Sciences
API      active pharmaceutical ingredient
 
CAS      Central Asian
CDC      U.S. Centers for Disease Control and Prevention
CHW      community health worker
CPC      cetyl-pyridinium chloride
CRI      colorimetric redox indicator
 
DOT      directly observed treatment
DOTS      Directly Observed Treatment-Short course
DST      drug susceptibility testing
 
EAI      East African-Indian
EXPAND-TB      Expanding Access to New Diagnostics for TB
 
FIND      Foundation for Innovative New Diagnostics
 
GDF      Global Drug Facility
GLC      Green Light Committee
GLI      Global Laboratory Initiative
GMP      Good Manufacturing Practice
GP      general practitioner
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×
 
HIV      human immunodeficiency virus
 
ICMR      Indian Council of Medical Research
INSA      Indian National Science Academy
IOM      Institute of Medicine
IRD      Interactive Research and Development
IRIS      immune reconstitution inflammatory syndrome
ISO      International Organisation for Standardization
IUATLD      International Union Against Tuberculosis and Lung Disease (“the Union”)
 
K-RITH      KwaZulu-Natal Research Institute for Tuberculosis and HIV
 
LAM      lipoarabinomannan
LED      light-emitting diode
LMIS      logistics management information systems
LPA      line probe assay
LRS      Lala Ram Sarup
 
MDR TB      multidrug-resistant tuberculosis
MGIT      mycobacteria growth indicator tube
MIRU      mycobacterial interspersed repetitive units
MODS      microscopic observation drug susceptibility
M.tb.      Mycobacterium tuberculosis
 
NAAT      nucleic acid amplification testing
NGO      nongovernmental organization
NIAID      National Institute of Allergy and Infectious Diseases
NIH      National Institutes of Health
NRA      nitrate reductase assay
 
PAS      P-aminosalicylic acid
PCR      polymerase chain reaction
PEPFAR      U.S. President’s Emergency Plan for AIDS Relief
PETTS      Preserving Effective TB Treatment Study
PKR      Pakistan rupees
PPM      public–private mix
 
RCC      Rolling Continuation Channel
RNTCP      Revised National Tuberculosis Control Program
 
SSCP      single-strand conformational polymorphism
 
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
×
TB      tuberculosis
TDR TB      totally drug-resistant tuberculosis
TLA      thin layer agar
TRC      Tuberculosis Research Centre (India)1
TST      tuberculin skin test
 
USAID      U.S. Agency for International Development
 
VNTR      variable number of tandem repeats
 
WHO      World Health Organization
 
XDR TB      extensively drug-resistant tuberculosis

____________________

1 Since the workshop, the Tuberculosis Research Centre (TRC) in Chennai, India, was renamed the National Institute for Research in Tuberculosis.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington, DC: The National Academies Press. doi: 10.17226/13243.
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Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research Get This Book
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An estimated 8.8 million people fell ill with tuberculosis (TB) in 2010 and 1.4 million died from the disease. Although antibiotics to treat TB were developed in the 1950s and are effective against a majority of TB cases, resistance to these antibiotics has emerged over the years, resulting in the growing spread of multidrug-resistant (MDR) TB. Due to challenges in timely and accurate diagnosis of drug-resistant TB, length and tolerability of treatment regimens, and expense of second-line anti-TB drugs, effectively controlling the disease requires complex public health interventions.

The IOM Forum on Drug Discovery, Development, and Translation held three international workshops to gather information from local experts around the world on the threat of drug resistant TB and how the challenges it presents can be met. Workshops were held in South Africa and Russia in 2010. The third workshop was held April 18-19, 2011, in New Delhi, India, in collaboration with the Indian National Science Academy and the Indian Council of Medical Research. The aim of the workshop was to highlight key challenges to controlling the spread of drug-resistant strains of TB in India and to discuss strategies for advancing and integrating local and international efforts to prevent and treat drug-resistant TB. This document summarizes the workshop.

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