subsequent workshops in countries with a high burden of DR TB. The first workshop in the international series was held in Pretoria, South Africa, on March 3–4, 2010 (IOM, 2011a). The second workshop was held in Moscow, Russia, on May 26–27, 2010 (IOM, 2011b). The third workshop was held in New Delhi, India, on April 18–19 and 21, 2011 (IOM, 2012), and the final workshop in the series is being planned for January 2013 in Beijing, China. Box 1-1 includes some key themes related to the drug supply chain that emerged from the workshops in Washington, DC, South Africa, Russia, and India.

The workshop summarized in this volume was convened by the Forum to provide a setting for fostering a dialogue on the needs and opportunities for a global supply chain for TB SLDs. The workshop brought together members of the international TB community—including individuals from U.S. federal agencies, international health authorities, nongovernmental organizations (NGOs), the private sector, academia, and advocacy groups, for 2 days of informative presentations and robust discussion. Box 2-1 lists the objectives of the workshop.

In her opening remarks, Gail Cassell, Visiting Professor, Department of Global Health and Social Medicine, Harvard Medical School, warned that failing to address current SLD supply issues would perpetuate the present situation in which the majority of MDR TB patients are undiagnosed and untreated while simultaneously fostering the development of rapid resistance to new TB drugs in the pipeline. Since the 2008 workshop (IOM, 2009), data have emerged to suggest that the burden of MDR and extensively drug-resistant tuberculosis (XDR TB) is underestimated (Wallengren et al., 2011) and has not only reached global pandemic proportions, but is being fueled by patients who are undiagnosed or who are receiving inadequate treatment (Keshavjee and Farmer, 2012). Data from KwaZulu-Natal, South Africa, show that 88 percent of XDR TB cases are untreatable with drugs currently available in South Africa.2 China has the highest annual number of MDR TB cases in the world; a survey published by the Chinese Center for Disease Control and Prevention indicated that 10 percent of Chinese TB patients have MDR TB, and 8 percent of those with MDR have XDR TB (Zhao et al., 2012). The same survey in China also revealed that primary transmission, or person-to-person spread, of DR TB accounted for 78 percent of new MDR TB cases and 86 percent of new XDR TB cases. In sum, Cassell noted that there has been an increasing recognition in recent years that DR TB strains are just as easily transmissible from person-to-person

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2 Data provided via personal communication, October 15, 2012, with Kristina Wallengren, KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal.



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