are not getting lifesaving treatment,” and she observed that resolving the problem would require concerted effort to scale up MDR TB treatment programs: WHO/Stop TB Department data indicate that only 19 percent2 of the estimated MDR TB patients worldwide were initiated on treatment in 2011.

Funding Inflexibility and Loss to Use

Inflexibility and mismatch of funding for SLDs is another key concern. An analysis of a randomly selected set of countries that compared the number of available Global Fund or UNITAID SLD treatment regimens to the number of MDR TB patients enrolled in 20113 revealed that only 39 percent of the available funds were actually used by countries for MDR TB treatment regimens. In other words, of the selected countries, only 30 percent met their planned MDR TB treatment objectives. This situation makes for an unpredictable market for manufacturers, donors, and technical assistance providers. Unused Global Fund funding can be reprogrammed for other important activities, but most of the time the country loses these valuable resources to treat MDR TB. However, it is also clear that a few countries are scaling up MDR TB treatment faster than SLDs are available in the Global Fund grants. These countries are not able to benefit from the drugs not used in other countries so they can continue to provide diagnosed patients with the lifesaving drugs. Vincent argued that more flexibility for available funding would allow resources to be matched more appropriately with enrollment and allow some countries to scale up faster, saving more lives and reducing the amount of MDR TB funding lost.

Country Capacity Barriers

Another challenge centers on insufficient country capacities for scaleup, forecasting, procurement, and in-country logistics. Global scale-up trends are erratic; some countries are scaling up more quickly than expected and many others more slowly. Due to the slower and unpredictable rates of national MDR TB program scale-up in countries like India, estimates about the number of patients to be treated are often unrealistically optimistic. The resulting discrepancies between forecasted demand and actual orders placed are problematic for manufacturers. Vincent noted the need for more regular reporting on the pace of MDR TB enrollments by country. WHO and GLC are now starting to monitor MDR TB enrollments by country every 6 months instead of yearly.

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2 Representing approximately 55,000 MDR TB patients.

3 Per WHO enrollment data.



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