Why are new drugs and cheaper, more user friendly regimes needed? "Tuberculosis, whether caused by drug-susceptible or drugresistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written.” Keshavjee and Farmer, NEJM, 2012* And what TB crisis? * Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6. Cost-ineffective? “…selective primary health care and ‘cost-effectiveness’ have shaped an anemic response to the ongoing global pandemic.”* *Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med. 2012 Sep 6;367(10):931-6. Slide courtesy: Prof Keertan Dheda SA : MDR-TB already >55% of TB budget! Financing the scale-up of MDR-TB prevention and Treatment. Katherine Floyd, Stop TB, WHO. Ministerial meeting. Beijing, China, 2009 http://www.who.int/tb_beijingmeeting/media/press_pack/presentations/day2_presentation3.pdf The perception among the majority is that we are not at risk of being infected by TB. This assumption is deeply flawed. Dr Madhukar Pai, India Tribune, 29 October 2012 The RNTCP needs to think beyond treatment of drug-resistant TB, and focus on preventing a major epidemic. In the case of drug-resistant TB, an ounce of prevention is definitely better than a pound of cure http://www.tribuneindia.com/2012/20121029/edit.htm#6 Care for the carer • ±1/100: number of South Africans diagnosed with TB last year (WHO, 2012). • 3x: increased rate of TB among Health Care Workers globally (Baussano, 2011). • 6.3%: confirmed drug-resistance among occupational TB cases at Tygerberg Hospital (Data: 2008-2011). • 5.56x higher incidence rate of MDR- and XDR (O’Donnell, 2010) • Means 3/100 HCW’s could be diagnosed with TB every year • At least 1/16 could have MDR-TB or worse Lucky and thankful… • Dalene got her life back, she can still hear, and can even practice as a clinician again…what next? TB PROOF Start at the beginning: nd 2 Year Medical Students Anyone can get TB Nobel peace prize TB survivors “UBUNTU” – I am because we are We are all in this together! http://www.health24.com/tools/Slideshows/1891-4704-4775,61850.asp HOPE: Life after TB SA record: 114m in one breath! Physicians: • Paul Willcox • Andreas Diacon • Simon Schaaf • Tony Biebuyck • Jantjie Taljaard • Keertan Dheda Pharmacology • Gary Maartens • Elsimé Kift • Jeannine Du Bois Supportive • Justus Apffelstaedt - Surgery • Mou Manie - Rheumatology • Anton Doubell - Cardiology • Mark Abelson – Cardiology • Prof Loock – Ear, nose and throat Radiology • Sucari Vlok • Arthur Maydall • Jan Lotz Occupational Health/TBH • Jack Meintjies • Sr Samuels • Sr Arendse • Matodzi Mukosi - super • Elmarie Malek • Mariana Kruger SAMA - Daniel Madiba Thank you! CBTBR/Genetics: • Gerhard Walzl • Belinda Kriel • Daleen Kriel • Rob Warren • Tommie Victor • Soraya Bardien-Kruger • Lizma Streicher Tibotec/Janssen: • David McNeeley • Gilles van Baar NHLS • Mariza Hoffman • Haematology and Microbiology Technologists Audiology: • Rene Visagie • Sharon Pithey • Tygerberg Audiologists CAPRISA • Nesri Padayatchi • Kogieleum Naidoo TB PROOF • Angela Dramowski • Bart Willems • Heena Narotam • Helene-Mari van der Westhuizen • Koot Kotze Treatment Action Group “The momentum to break this disease is in real danger. We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.” Dr Mario Raviglione; Director of the WHO Stop TB Department; 17 October 2012 Questions?