Situational analysis of the 10 high drug resistant tuberculosis burden countries two years post-UNHLM declaration: progress and setbacks in a changing landscape.

Monedero-Recuero, Ignacio; Gegia, Medea; Wares, Douglas Fraser; S Chadha, Sarabjit; Mirzayev, Fuad

OBJECTIVES Drug-resistant tuberculosis (DR-TB) is the leading cause of death globally related to antimicrobial resistance, affecting 500,000 emergent cases annually. In 2018, the first United Nations high level meeting (UNHLM) on tuberculosis, declared DR-TB a global public health priority. Bold country targets were established for 2018-2022. This study reviews the DR-TB situation in 2018 and the UNHLM targets accomplishments in the 10 world high burden countries (HBCs). METHODS Ecological descriptive analysis of the 10 DR-TB HBCs (Bangladesh, China, India, Indonesia, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, and South Africa) that share 70% of the global DR-TB burden; complemented by a cascade of care analysis and a survey gathering additional information on key advances and setbacks 2 years post the UNHLM declaration. RESULTS Most countries are showing historical advances and being on track for the 2018 and 2019 targets. However, according to the cascade of care, no country is capable of providing effective care for 50% of the estimated patients. Increasing levels of fluoroquinolone resistance and access to timely susceptibility testing can jeopardize ongoing adoption of shorter, all-oral treatment regimens. The programmatic management of DR-TB in children remains minimal. Achievements for 2020 and beyond might be significantly affected by the COVID-19 pandemic. CONCLUSION Triggered by the COVID-19 pandemic, there is a global risk of recoil in DR-TB care with long-term consequences in terms of deaths, suffering and wider antimicrobial resistant transmission. Investment to support DR-TB services is more important now than ever to meet the aspirations of the UNHLM declaration.