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Open Access Tackling drug-resistant tuberculosis: we need a critical synergy of product and process innovations

The End TB Strategy diagnostic pillar calls for access to high-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). The recommended diagnostic technologies available in low and middle-income, high-burden countries for multidrug-resistant tuberculosis (MDR-TB) are essentially limited to Xpert® MTB/RIF and MTB/RIF Ultra assays, culture DST and the line-probe assays. The primary reasons for slow scale-up are insufficient political will, and therefore, insufficient funding for qualified human resources, and safe laboratory and health system infrastructure. Innovative approaches to enable the private health sector to provide high-quality diagnosis are also needed. The Essential Diagnostics List provides impetus and a standard benchmark for the rational implementation of MDR-TB diagnostics, but the epidemic will ultimately only be favorably impacted by complete end-to-end solutions to patients that address the complete cascade of care, including patient-centered diagnosis and treatment of TB and MDR-TB, management of comorbidities and social protection. By scaling up access to the currently available diagnostics, we lay the groundwork for future innovations for rapid accurate diagnosis of MDR-TB, which in turn will bring us closer to meeting the targets in the End TB Strategy.

Keywords: TB; access; equity; multidrug-resistant

Document Type: Research Article

Affiliations: 1: Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Department of Medicine, Dartmouth College, Hanover, NH, USA 2: McGill International TB Centre, MontrÉal, QC, McGill Global Health Programs and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, MontrÉal, QC, Canada, Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India

Publication date: July 1, 2019

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