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Global Health Econ Sustain

PERSPECTIVE ARTICLE
Multidrug-resistant tuberculosis: Successes,

challenges, and the road ahead

Dominic Worku *
1,2
1 Morriston Hospital, Swansea Bay University Health Board, Swansea, United Kingdom
2 Public Health Wales, Cardiff, United Kingdom

Abstract

Tuberculosis (TB) is a leading cause of infection-related mortality globally and
imposes a significant burden on morbidity among survivors. While progress has
been achieved toward the World Health Organization’s End TB goal, it has been
slower than anticipated and, in part, reversed by the impact of the severe acute
respiratory syndrome coronavirus 2 pandemic. Multidrug-resistant TB (MDR-TB)
presents a formidable challenge, characterized by catastrophic costs, reduced
treatment success rates, and increased loss to follow-up, leading to its perpetuation
in local communities and the risk of onward transmission. Given this, the need to
reshape services and refine management in a cost-effective manner is of paramount
importance, particularly in developing countries where the majority of cases reside.
In this short piece, we discuss the economic impact of MDR-TB and how this impact
can be mitigated through several methods, including decentralized models of care.

Keywords: Multidrug-resistant tuberculosis; Tuberculosis; End TB; Economics;
*Corresponding author: Management
Dominic Worku
(dominic.worku@wales.nhs.uk)
Citation: Worku, D. (2024).
Multidrug-resistant tuberculosis: 1. Introduction
Successes, challenges, and the
road ahead. Global Health Econ Tuberculosis (TB) is an ancient disease, causing an estimated 1.5 – 2 million deaths/year, with
Sustain, 2(2): 2876. 99% occurring in developing countries. Until 2020, TB was the leading cause of infection-
https://doi.org/10.36922/ghes.2876
related deaths, only surpassed by the severe acute respiratory syndrome coronavirus 2
Received: February 4, 2024 (SARS-CoV-2) pandemic (Molla et al., 2022; Gunther et al., 2023; Falzon et al., 2023).
Accepted: April 7, 2024 While management has evolved over time, so too has the fear surrounding TB and the

Published Online: May 20, 2024 development of resistance(Riccardi et al., 2020). In addition, the clear association TB has
with poverty, social deprivation, and under-resourced health-care systems contributes to
Copyright: © 2024-Author(s). its resilience to eradication (Menzies et al., 2023). In 1993, the World Health Organization
This is an Open Access article
distributed under the terms of the (WHO) declared TB a global emergency, and since then, the emergence of multidrug-
Creative Commons Attribution resistant TB (MDR-TB) has spread in Europe, Asia, and Africa (Ou et al., 2021; European
License, permitting distribution,
and reproduction in any medium, Centre for Disease Prevention and Control, 2023; Bu et al., 2023; Suppli et al., 2022).
provided the original work is MDR-TB is defined as resistance to rifampicin and isoniazid, two key therapies utilized
properly cited. in drug-sensitive TB (DS-TB). Rifampicin is instrumental in improving clinical outcomes
Publisher’s Note: AccScience through its bactericidal effect on non-replicating mycobacteria and enhancement of
Publishing remains neutral with sputum conversion rates, thereby curtailing transmission (Onorato et al., 2021). Moreover,
regard to jurisdictional claims in
published maps and institutional subtherapeutic rifampicin concentrations achieved by standard dosing regimens in DS-TB
affiliations. are a driver in MDR-TB pathogenesis (Seijger et al., 2019).

Volume 2 Issue 2 (2024) 1 https://doi.org/10.36922/ghes.2876