Table. Suggested plan for ensuring the appropriate use of new TB drugs and regimens*.
| Goals | Support | Feasibility/precedent |
|---|---|---|
| 1. Improve DST in high-TB-burden countries | ||
| A. Increase number of laboratories performing TB culture and DST | Key goal of WHO (1). Funding available from UNITAID, FIND, GLI, Global Drug Facility, Global Fund, United States government, World Bank | Ongoing global scale-up of DST during 2006–2015. EXPAND-TB project has improved technology in 97 TB laboratories worldwide (1) |
| B. Improve TB diagnostic technology in existing laboratories, including rollout of molecular diagnostics | WHO, NTPs | >3,000 GeneXpert machines procured at concessional prices since WHO recommended use in 2010 (1) |
| C. Develop a specimen bank of TB strains resistant to new antibiotics | WHO, private sector (both diagnostic and pharmaceutical companies) | TDR TB strain bank launched by Special Program for Research and Training in Tropical Diseases |
| 2. Improve prescribing practices in high TB burden countries | ||
| A. Establish accreditation process for prescribers of new TB drugs | National governments, NTPs, pharmaceutical companies | Similar programs instituted for laboratory services in low-resource settings (25–27) |
| B. Ban over-the-counter sale of TB drugs | Widely supported by many NGOs and other authorities (15) | Common practice in many countries; new regulations instituted in India in 2014 |
| 3. Support community-based treatment of MDR TB | ||
| A. Employ community health workers to assist with MDR TB treatment | Supported by WHO (1); to be implemented by local NTPs and NGOs | Beneficial role of CHWs in TB care well described (1) |
| B. Use emerging mobile technologies to monitor for adherence and adverse effects | WHO recently acknowledged value of mobile health technology (35) | Well-studied for HIV care; data for use in TB management emerging (29–34) |
| C. Enlist support of existing civil society organizations | Wide support on global, national, and local level | Many such organizations already invested in improving TB care |
*TB, tuberculosis; DST, drug-susceptibility testing; WHO, World Health Organization; FIND, Foundation for Innovative New Diagnostics; GLI, Global Laboratory Initiative; EXPAND-TB, Expanding Access to New Diagnostics for TB; NTPs, national TB programs; TDR TB, totally drug-resistant TB; MDR TB, multidrug-resistant TB; NGOs, nongovernmental organizations; CHWs, community health workers.